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NBME 22 Answers

nbme22/Block 3/Question#5 (reveal difficulty score)
A 72-year-old man with multiple myeloma ...
Unrearranged immunoglobulin gene 🔍 / 📺 / 🌳 / 📖

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 +70  upvote downvote
submitted by sacredazn(101)
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The tcencop is a ctdneuloov yaw of sankig if ouy nekw woh JVD orcinmaotiebn rkw,so hcihw si ttah it si aallucyt an mlpeaex of arnitelg teh NDA of het /TB et.oypylhcm

rthouSen tlob euhectni:q oS nhwe yteh esu a erobp asantig mseo in,roeg nda ignputoutt a eszi of 51. bk ro 6 bk, hist si lilngte you eth isze fo hte DNA amftnrge ni ahec lelc ’dseno(t atemrt fi yeht asy J eobpr ro tcotnsan nrgeoi poerb, erhe’yt sutj nsgyia yte’hre gagtnrtei meso lnuietcode esuecneq dounf in eht Ig ClTosu/Rc eatb ianhc lcous leteecirpyvs ofr T/B sl.)lec

I htikn hte usfocngni rpat cdolu be gowdneirn who uoy owkn hertehw oy’rue aptryl gothrhu ramtreeangnre srwe(na seicohc B turh )D ro fi ti ts’ahn dcreuocr ta lla tye trceoc(r ).ranews e,reH the cenotpc si ttha B slelc godrnue VJD() grretrnanaeem in eht eonb wmo,rar leiwh T lscel od ti ni the sty,muh nda it lla psaenph ta e.ocn So a maspal cell ni het obdol iekl in puleiMlt Mmoeyal dlwuo avhe ullyf unegoednr eic,omnnribota iwelh a T llec in teh lbdoo odlcu ieerht be llfyu tuceeadd (dan vhae sifhenid VJD oitabeo)icrnnm ro umteirma hsa’(tn ttresda )V.DJ

Seicn teh T lecl geen saw 6 kb dna fiyeneidtl rgibeg anht het 5.1 bk neeg, the T lcle n’hast nenodegur bearinocotmni ey.t

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trichotillomaniac  very nice explanation! +29
nwinkelmann  This was awesome! Made so much sense and hopefully I will be able to think that critically about questions in the future (because I NEVER would have come up with this on my own, hah). +5
eacv  OMG! THANK YOU. I DIDNT KNOW ANYTHING about this!! Hope this is not testesd on real examen :p +5
ajss  wow! this explanation was awesome! thanks! +
mrglass  Also the T-cell V-D-J segments are not the same as the B-cell V-D-J segments. Therefore a B-cell J segment southern blot would look for whether the B-cell site VDJ segment in a T-cell, which would always non-rearranged. +6
mynamejeff  Thank you! So is this because multiple myeloma produces excessive monoclonal light chain Ig? Is this the 1.5 kb gene? Whereas, T-cells that have not gone through differentiation yet and their J region includes everything (VDJ) vs. just VJ in the light chain? (FA 2020 pg 104) +
peridot  This explanation is amazing! However, to fully understand another step of what the question is getting at, please take a look at @highyieldboardswards's and/or @mrglass' explanation as well - a very important addition!! +1
skonys  My logic was wrong but my answer correct. I am suffering from success. +
fhegedus  wow! this is amazing! thank you! +

 +18  upvote downvote
submitted by highyieldboardswards(18)
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othrS aswern: llA gesen era eetrnps ni tbho B and T sellc, utb tyeh gerranrae nda ersesxp rcpoteres htat aer cfsiicpe to etrih a.eenilg rThie rea pedntinnede DVJ engsior rfo B lecl ceoetprr ritgnnoeea dan T clel teorrcep no!iegarnet hTsi kiiw aictler sdesh tihgl on hi:st


I oot tcylraglai ssemdi ..hsit tbu ti is yuctalla os smeipl tath ew rae nmgiiss eth etrfso hotuhgr het erste ieW hl-- tbho B nad T lecls udoreng DJV tremr,ragnnaee het ,V D, dan J eegns are DFEIRFETN EEGSN epetisd gnbie eiagodzrn nda efheroret alciidfess in a rmsilai osnfhia edu to eihtr ersdah ndee ot enratgee disvere .custrstuer To aemk rttaems orme onfu,igsnc btoh stes fo JVD sgene era on heomocmors 41.

siTh is ywh hte BMNE pefceisid ttah tehy are itgngag EHT SAEM J RNGEIO chhwi si atht fo het B cell ptocerer eeng J neroi,g tno teh T clle rctrepoe gnee baJ-et inergo ee(s ikwi cr).iaetl Teh B ecll tepecorr gnee is not gnreeradar ni a T le,lc if ti s,wa T lelcs dulow evha d!aenisoibt

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redstrat  This. So much this! +1

 +5  upvote downvote
submitted by david_bball(5)
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The ywa I tthough utboa ihst iunosetq was ttha in MM eehtr si a TON of bioteaisnd ebgin ,dmea so the VJD smetneg si egnib krnobe pedeet//lenerrrsadcuag naym smite and has eneb ehtrneods ot 15.k.b sA fro eht T C,esll tath rinoge s’tni igben udes nis(ce terhe si no olacln oapnixnes or oil)tcsene os ’its stlli tgo teh lful k6b lhtneg uotneh.ucd

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d_holles  T cells still undergo VDJ recombination to form their TCRs. +7

 +2  upvote downvote
submitted by sam1(22)
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ehiWl T cllse do sue eht JDV mcanieirn,otob eth T cell copterre saihnc rea ideffnetr nesge rfom eth B l'cesl hevya dan htlig sh.nica Seinc yhet euds a B llce nigroJe- perob, het T lsc'le band lliw be much lerarg sa shit area fo ist DNA eth( B llce avehy or hgitl canhi eseg)n hvae nto nebe rderenraag -- iedtsna sit T lcle perocter enseg vhae enbe a.dreenrrag

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