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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!SUG You larley avhe ot olko at eht xais sbll.ae hTe iqsutone ssay het ps.'t aoiysttnheicn hestysna itavtiyc iays-)(x is ROALNM itwh an RNAECSEID uonamt of pyloxraid pphsateho -ix).s(ax x-aisY is hte msea sa ARML,ON i-xxas fitshs ot eht trgih wgishno NAEIRESCD lxadryiop epaosphth

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skonys  mamI jtsu teka teh L no htsi eon fi it oscem .pu I saw leab ot owranr ti donw ot B a&m;p C esceuba if yeht era icirgeansn rpy hspo adn ta osem onpti the cisnetythoa stanhsey caityvti is noml~ra~ nteh ti tsum tetcseirn eth ralmno tlpo obrbapyl at the Y eacssc orf enrosas I do'nt kwno ti usjt selef igtr.h D dnetso cientetsr ta lla. A estnetrics ta iensyasetll /01 ttavciyi kedi( if that ameks nesse ubt it jsut koeldo su).s oS tneh I saw ewtbnee B dna C dan thb at atth pitno I knhti yuor best ebt is ot 00/55 ti adn oevm no htiw oruy ilef essnlu uyo ntaw to do erdm ro heingmsto nad ende to tge it orecrct ubt htwa do I wkon? I go to eltadn .lsoohc +
umpalumpa  I eseidgra ihtw muhasaes l.anxtonpeia eTh xsaxi- has oax1diry/pl thppas,eho whhic masne hatt ginog ot teh irhgt no het sx,ix-a vsl fo drpoxylya oshptpseah rea relow (dan eht nerevs=i ro1ap/ixlyd hp,tphoeas oseg e)gr.hih +
sahusema  mlaamup@pu tis' eneb a lgon temi ncsie I tdoesp htis, btu newh uoy do sthi ↑)X,-/1( uoy apcopahr 0 mginnae uoy idsle the phrga to het ghrti +1



 +13  upvote downvote
submitted by amirmullick3(76)
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eTh ieneveLwra Bruk otlP is iaylmn rtnterideep yb ist X and Y pentTs.hiec etr nesiuqto atsets ttha ivigng B6 rsneiscea teh yvcitita to mrolan ellves, hhcwi emnsa hte vycttiai shulod eb eht meas as teh nenm. Hearocl, rhiet Y ircpenett dosulh eb hte esm,a os ew era enbwtee hsiecco B adn .C A nad D od tno ahve eth emsa Y ncettirpe as lmer.Hgrh inoa ancsninoecrtot fo 6B cudesa avyiictt to mebcoe omlnr,a dan so xmVa will nto eb aggnhnic dan we nca calnce A nda .DA hsa a rwole Vxam and D sha a mhuc ihgreh mxV.T aeh fiedefnrce ebeewnt B and C is ni rhtei Km. vMgino ot teh ftel no eth X axis easmk hte mK orwel nad lselt oyu ahtt naifyfit is rghsh eio uyo lwdou not edne emro B.6 utB in ruo saec atfinyfi fo hte eyezmn rof 6B is lerlay ,olw whhci is yhw we ened a tno oemr B.6

nI mumry,as we nawt eth smea aVxm dna a erhigh KeW.m tnaw the lar"no"m avyctiti esma( xmva sa nrm)alo nda we dene hhigre sumnato of 6B orf sseuccs iof fynaits of teh myznee rfo 6B si loabrpby ervy ol.w

ihoceC B hsa a )(-1/mK elauv eoscrl ot 0 wchih smena mK is oerlw adn aiffynit of teh eymnez fro tsi teubrssta si espru h.Twosl i meska essen as vnggii ehirgh nsuatmo of eht "ttcmveiiope" arussbtet 6B is neipgl.h

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apurva  Tshi laitxoeanpn si !gro !n!Xw siax si not 1/km in hte usqeiot,n ti si oax/rlp1ydi ohphaspe.t m(/1k lushod eb ions)c/1etemohy sAlo the tnqueois si kngsai buoat talcosiler atnoaciitv of ihnctasteoy stsneayh due to dinotida of dlorpixya eaoph.tsph ichWh esnam eth Km ohusdl reacseed yiaffnt(i sieescran etarf anoidtid of dnisgie.non)roi pexdCriy the x iasx to eb dx/oyral1ip pepohshta, own lpypa smeipl oicgl of m,tahs reciensa idprxlayo sptehahop = nggbrini inel rmeo esolc to oerz c(bausee ti is iyr-1loadxp/ phshoe.pat) +13
apurva  aHd eth X ixsa be ,k1m/ the eswnra lushod be C +1
pinkdinosaur  mK si nyvrieles artdele to het ifaiytfn fo eetym eznh orf tis etu .aTtherssb elsrco ot 0 no het Xsaix-, eth herhig hte .AK Fm 2200 pg 032 +



 +12  upvote downvote
submitted by lamhtu(139)
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Nnedige "hhrgei ootrsinantc"enc fo teh B6 orf nmzeey ciyttiav si erntaoh ywa of gansiy Km is rhgihe nscei oerm is eedquirr ofr 1/2 vamx yiv.tatic nrdcesIea Km aleusv urtsle in mK/1 egibn sealmrl er(losc to 0 on teh xix)a-,s cwhih is ttedsmdaoenr ni swnrea cihcoe .B

A ""loanrm meneyz cvtatiiy ni teh ecprnese fo ihgher 6B roscntcnaneiot msean thta aVxm si ont ga,nngich btu Km .si

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d_holles  nI oterh srwooa,rmNdl nymzee ticatyiv = ixm dgAnVad rome 6B ot a mttuade znyeme lliw erpmiov ti bakc ot arlonm amVx( yssta toantcsn, os Km lwil deeceadrs ude to ↑ tnaiiyff fo teh .)mezyen +3
jatsyuk38  ^^ STHI is eht tbse atinlonxape +
drdoom  s@tja3yku8 the ceomtnm ro the noscum?mebt +
drdoom  oh, ebuodl acetr = puubmbm,p = eth ntcomem @)thamul( +



 +4  upvote downvote
submitted by trazobone(97)
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mSoe fo ehest ptxeannsaiol ylrlae ndgoi hte stm.o fI eth mynzee si elba to reisncae ot arlnom ytaicvti hitw a gehhir elvle of het stetaub,sr ahtt msean ’rwee in a etcmeoptvii birothnii itt.insoau Ctvoteiipem slayaw crseoss on het rag,ph so we nac nletameii A nad D.

oNw ew aaynzle .Km eW wnta almsl mK’s fro onttpe zmynsee. zieS osde not wyslaa etarmt 😉. ceptEx in iths esac we ’dtno awnt atht ,ctypone we wnta to kool rfo a ry/1lla(e igb )mK, val(eu atth si ercosl ot rzeo,) cb ew wtan a keaw igb mK ot eb lbea to roowevrpe the tptemecvioi o.ibtnirih igCpnrmao the mgerninai 2 cei,cosh B hsa a Km aeluv clerso to ozre so het’sre uroy ar.nesw

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 +2  upvote downvote
submitted by navevan3(2)
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For sith itu,nqose I aws tgnknihi ttha etyh ksead oyu eacmrpo ot a mo“nalr” speonr, so eht xamV ld’tuwno agnche neics yeht estat atht sih aititcyv teusnrr ot a loarnm vle.el nlyO teh ax-isx lowdu ensci ti olduw eb ta aecdniers tnnoiacsorntec in crnm.asoopi

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 +2  upvote downvote
submitted by an_improved_me(91)
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So i nofud hits teionsuq .ucldoi.r.ius hte eonaxstplain dpvioerd did not lraley rlcea it up ofr me, tub i ktinh i datsreunnd ti wno eseal(p rtrccoe em fi mi' g)o.rnw

irtFs dna ,orstemfo I'm ont evne ruse fi hist is uyltr a vrwriebn-aleukee o,ltp sniec het isaxX- si ont 1/m.K

t,Bu omre yngelare,l I ietrd ot dueannsdrt hawt ahnepepd at thbo emsxerte of [P]LP adn yeotil.cV

sA:kP LP ysolufr:e wreeh on teh raphg is PP]L[ geshhti? Wl,le if teh sxiaX- is qeula to LPP1,/ LPP dwoul be at sti tsehhig ta het leauv tclsose to 0 no het x.si-xa k(th:in wtah si 1 edvddii by a bli?ioln VREY CLEOS OT ER.O)Z hTsi uwdol cpoorsredn to a otinp oalng eth sxiy-a for eht nymezse ivytitac. In eroht wdrs,o PLP is at tis hsiehtg tctnneroaionc ta teh hrsgap p.-rcetYteni

Rerebmem athw ew oals d:asi nehw teh tuadtem eeznym si dnuroa tosl of PL,P it sayillcba tsnuocfin ilke a nlm .menzey hisT mse,an tath het aVmx fo het eumtadt mzyeen si qluevneita to teh Vmax of teh omraln nzm.eye rh,eeofTre The m1/Vxa of obht nzeemys era ..ive.ualqnet ta eht rhpiect-i snT!ety si !gib If uyo gte htsi rf,a nhte you nac eleainmit A() and )D(, eincs ehtse hgprsa hvae tdeiffenr pnertt-esYic idrene(tff xme-s)aV rof retih peecstveri n.yezsme

gnoviM o.n..

lcoetiyV V:)( Wh ne V si at its tsigehh (..ei V),xma teh uvlea of V/1 lwdou eb ta tsi .tlwoes ng:aA(i hknti of it placcyt:irla hwat si 1 ivdidde yb 1 ?linoibl )0~! h,rerofeeT hte vuela of 1/V si at ist olwtse whne hte ayis-x si luqea ot 0. eroeThf,er eTh xmVa of isht uorccs enhw teh a-yixs si oslce to rz...oe eeHrs het tinhg ht..o steeh eenzmsy reruiqe fdeiterfn svlele fo PPL to teeopar ta V-mxa. beRre,mem teh x-Vma of eht UMAETTD yemezn wlil pnahpe ta a muhc HIRHEG [P].PL Or ,ovyeclesrn the a-Vmx of the ALMNOR nemeyz lwil nhpape ta a cumh EORWL [P..LP].

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an_improved_me  Me,ngani when ew kloo at teh pXetcitrn-e hn(ew V is ihegsh,t) eth ttademu nzymee illw eieqrur meor PP.L rMoe PPL sanem a we"ro"l evalu no teh -aixsx slerc(o to zo)er iaetvrel ot hte monrla enemzy. +1
an_improved_me  tngPitu ti LLA eoh:trgte tpiyrte-n ec lilw eb the amse rfo otbh /aruntolemdamt -nnretcmexzeie tp iwll eb ecolsr to 0 orf het etdutam yee,mzn evirteal ot the lrmano .myeenz hTe nyol enwars atth ash btoh tccroer pislsrhtinaeo is (.B) I hktni i epsnt 5 munitse on tihs iqsntoeu nryitg to friueg ti uot. I prbylboa wlduo haev eednde 01 nuistem to lyclaaut egt eht.er uyloeflpH now I nca teg it qrceiku fi nimtgsoeh ikel stih osswh up no the lera gih.tn +2



 +0  upvote downvote
submitted by minhphuongpnt07(5)
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eb wraea hatt teh -axixs ofr hsit onieutqs si otn mK"" iB(6vt si otn het t' rsbthusatate B]Vi.[/t16 to sipfiy,m eseaucb eth maVx si ngaon asty het sem,a oyu utjs eend ot rniaeces 6Bt[i]v to etg eht saem Vamx aak( hstfi to igrth no het .ixa)-sx Dt on' eb fdleoo uoarnd yb eth tuseqion rwri.te

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poisonivy  itsh smaek nesse ot em, X nacont be m!K! ecbueas fi ti was mK tenh lnie B uowld be nihsgwo a tiecetovpmi" tihib"niro fe,ftec hhciw oacntn be the aces escni htey tstae ttah eht ymenze vctyaiit sencisare to rolanm trfea B6 itnmdiorsiatna os it fasovr eht oiracten stanedi fo aeecsreds t.i I got htis eno onrwg of crueso, too cirkty rof e!m +



 +0  upvote downvote
submitted by empem28(1)
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odNoby sah rnweedsa hsit suqeoitn ruhthog eht lsne of a aeilrgnn voebijtce eitqu tye so ehser' ym 2 n:estc Km si SNICADREE bc isth enttapi has na enzyem tiwh na vrleoal WORLE ffianyti ac(n be crdrecote ot rmanol rtfae na rceinsae ni )ustrtsbea ichhw si aracehttsicicr of EVEMIOITCTP itonb,hiini cwhhi is hwy hte inel fo eth tp. si noe fo tcvioieptme inhiniotib on a BL lpto

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 +0  upvote downvote
submitted by stapes2big(16)
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ehT inseqtuo si aalcilbsy egttnis up a nutasiito miailsr ot htta fo a ipcmveettio itorh.bnii eThy sya ttha reihgh tonientroscnca of xrpyodlia tsphaehop esniserca eht tiictavy of het nyzmee to nlroma e.lvesl ra,mSlliyi wenh you hvea a etcmpivtoie ihbtrinoi nad csieearn the teiocarcntonn fo ta,rstsube eht neyemz anc echviae teh seam axmV sa if wuthtoi the nohiirt.bi

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 +0  upvote downvote
submitted by usmleuser007(464)
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Reemmber )1 tpvctmoieei brntisiiho ~ senil soCrs ta ye-sirt2 ectn) poni-Nietmtcoev itbhiniosr ~ on nlie srosc

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 -5  upvote downvote
submitted by hungrybox(1277)
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nLgo earswn ,aaehd utb aebr htiw em.

NHT:I v koslo dkin fo ilke y, aeesrhw k skloo mreo ekil .x

ernpyt-tcie = 1xV/ma

  • Vxma si eht epurp tmili no ohw afst a rtacenio si edlaycatz by syen.emz

iretntcepx- = /1mK

  • mK is a rinngak of owh good an nzeyme is ta bniidng sti sarts.uteb nA mneyze with a iagknnr fo 1 si bettre at ibgdinn tsi rsutsbaet athn an znyeme iwht a nginakr fo 5. Lrwoe( mK = rtbete mnze)ye

teoN taht xmaV, sa a aesuemr fo cerfnroaemp, anc be atredel hutrohg mnay sniht.g Mnea,ilwhe Km si a est catthiacicsrre of eth mee,yzn dan tnncao be reteadl.

nI this emaxpe,l teh ymnzee rafmnoeeprc )V(amx is eedacirns yb enniairgcs the mvnatii coartofc so tath ti ahcsere a ""mralon tiv.yiact e,ervHow eht yzneem si lilts ynietehlnr htisty deu ot a alengtconi eet,cfd os teh mK stays eth s.mae

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mnemonia  ewAesom. +
ht3  wtai ieln B sswho the amvx sdento' hnagce adn ttah hte km si tgiegtn larrge nmy(zee si lilst httisy so rlegra )km os m/1-k lowud eb a slealmr nmbure dna ldouw aarpohcp 0 +1
lamhtu  uYo ysa Km nnotac be retldea nad ist tasgnyi eht em,sa ubt eht aersnw of eth rhpga assttreondem a erhhig mK aige e.nlNev ud r"gehhi intenraos"contc of teh B6 rof meeynz tiatvicy si otarhen ywa fo ynsgia Km is hhierg encsi mroe si rdreqiue orf /12 vmxa tyicativ +18
sbryant6  ehYa hits eanpotixlan si .wnrgo +
kcyanide101  n,tHosyel isth iuestnqo is ubbgrni em eth ongwr .aw.y.. fI ew go yb eth iLne weerva rkbu ptol, ehnt "C" is eth rcrotec ,asernw euebasc ""B si hiwsogn oieimetctvp .iiti.o.hnrb. eTh eeyznm here is tyeeviiptolmc avnica.ti tg meneoSo neesd ot xlpeian tshi tetebr e,psale soem of su paid on stih urfmo to teg a elfngauimn tiaonlpxena dan not iuobnsiorttcn morf lwloef etts l sl.eot.a.r.k +



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