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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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 +78 
submitted by aishu007(4),
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vEloisenta in doyb epmurtretae rucoc hwen erntsooaccitnn fo lsgnrdtoaapin 2)(E P)EG2(() cisenaer hitiwn tcaiern aasre fo het ibre.shnTea oitesvnael erlat teh iinrgf taer of onesnur atth noocltr trgomeeulhroniat in eht h.hmautoysl.pa It si onw crela ttah tsom ycnrieistapt kwor yb ntgibhniii het zmyeen exsgocoanyyelc and cdiegnru eht vsleel fo EP)(2G hntiwi hte oslh.tapuyham

4n:1unvptm.16wmct.pi.be5l//bn/1.wihw/o6sdh6g


 +69 
submitted by sacredazn(100),
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hTe pctnceo si a oncvuldteo way fo ngiska fi uyo kwen who VDJ rnbmioaioenct o,rkws wcihh is atht it is ylcaautl an epemaxl fo ilragtne hte NAD fo teh B/T .coyeymtplh

ohrneuSt lotb qiuhtence: So newh etyh sue a boerp aistgna soem ngr,ioe nad ounttiptgu a zsie of 1.5 bk ro 6 bk, shti is geiltln ouy eht esiz fo eth ADN naetgfrm ni aceh lecl s(tdn’oe tartem if tyeh sya J eobrp or nnoctats rioneg op,bre rtehey’ just anygis reh’yte tgaintegr esmo dlonucteie ueescqen donfu in hte gI /uCcsRTol tabe chnai oslcu eieevyclrspt rof B/T lsec).l

I iktnh eht ocsgnufni prta dulco be dnerniowg hwo uoy konw hehertw ’eryuo prlyat guhrhto rmratrgneaene sn(wear secicoh B htru D) ro if ti n’htas ucceodrr ta lal tye (rccoter aren).sw ,Here teh enptcoc si atth B eclsl dernoug J(D)V earrnmtneaegr in eth nobe wrra,om lwihe T clles od ti ni the y,thusm nda ti lla ehappns ta econ. oS a maapls lcel ni eht obldo eilk in ltMuliep lMoamye wdlou heva uyfll deonrnuge ,nteicboniramo wilhe a T ecll in the ldboo uldco reieht eb ullyf euaecdtd (nad veha fidnseih DJV oiabrot)incnme ro aeimmutr sn(’hat ersdtat DJ).V

iencS eth T llce eeng saw 6 kb adn ityildeefn gbrieg than het 1.5 bk e,eng eth T ecll sthan’ orugdenne omoanbiercint ey.t

trichotillomaniac  very cien ixnpt!noeala +29  
nwinkelmann  ihsT swa aseemw!o Maed os hcmu sesne dan polfeluhy I iwll eb bale ot htnik ttah ycrlailtci bauot uteinsoqs ni eth freutu seubac(e I NEEVR oludw haev mceo up hitw htis no ym n,wo )hh.a +5  
eacv  OMG! HKNTA OUY. I INDTD WNKO TAIGYHNN uotab ts!i!h opeH tish is otn edtstse on arle naeemx :p +5  
ajss  o!ww siht xanepltaino swa o!measwe tks!hna +  
mrglass  sloA the T-clel D-VJ- gtsensem ear nto eth saem sa eht ecBl-l DV--J tgesn.ems eorefhTer a le-clB J tsgneme rsnoteuh tolb wdolu olko fro hrtwhee hte cBel-l ites VJD msetneg ni a Te,-cll hchiw oldwu sawyal n.ade-anonrergr +6  
mynamejeff  aThnk y!uo So si tshi uesbeca ilpetmul ayoemlm rdospeuc svxeceies loolomnanc light cnhai gI? sI ihts het 51. kb geen? rs,ehaeW sTcle-l htta vahe tno egno orughht teeifntnrfoiiad ety adn teirh J eginor sdeiclnu itvnrgyhee VDJ)( sv. tujs VJ in teh ilght nhci?a AF( 2200 pg 04)1 +  
peridot  hsTi aoanepnltix is azgnami! orweeHv, ot yulfl nasutndder rthenao spet fo wtah teh uqenisot is ntigetg ta, eesapl teka a olko at y@d'arhsdgwlsiioerbsahd o/ardn sg@lm'rsa npxoealntia sa wlle - a revy itopmrnat ni!idtod!a +1  
skonys  yM cgoil swa wrngo btu ym wresna .reotccr I am neurisfgf form euc.csss +  
fhegedus  o!ww itsh is mgnai!za hnatk uoy! +  



 +18 
submitted by highyieldboardswards(18),
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hoStr n:aewrs llA eegsn era estrenp ni thob B nda T cles,l ubt teyh ngearraer and xpreess rrecetops tath rea ifcisecp ot rthei e.agnile ieThr era ndneentepid JVD resgino rof B llec rpteroce oatenigner dna T clle tcorreep tienaonrge! hiTs wiki arcitle hdses htigl on :shit

ciwTsm/ae_:iJe/irte.lDakobrnptei./(ocletw)oihpViorp/d#kec_sngn_rti

I oot laclagyrti meidss t.i.hs btu it is ylaucatl os lipsem ahtt ew rea siimsgn het fortse ouhrght het erets iWeh-l- boht B dan T clles grudoen DJV nt,rrageernmae hte V, D, and J neges ear TFEEDNRIF ENEGS ptdeeis igneb zeadriogn dna eeftorreh lfdssceiia ni a iilasrm ofahnis due ot tiehr resadh ende ot atngeeer sdverie rttsesru.uc oT keam teamrts omre uncniso,fg both sets of JDV nesge rea on shcmoemoor 41.

Tsih si ywh hte BMNE idifespce tath ythe rea gintagg ETH MEAS J EGNROI cihhw si htta of eth B ecll rerepoct gene J giore,n tno teh T lcle retopcer nege Jta-eb eionrg se(e wiki .aricl)te heT B ecll cpterroe ngee si nto earrrgdaen ni a T llce, if it ,wsa T sllce wodlu aveh !oesiatinbd

redstrat  .Tshi So uhmc t!sih +1  



 +5 
submitted by david_bball(5),
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Teh way I thgutoh tobua tshi qseiuotn asw ahtt ni MM herte is a NTO of aisntobdie gnbie d,eam so het DJV esengtm is ingbe bkenor grasep/daeueedteclrr/n nyam msite and ahs eneb hondsetre to bk.5.1 As orf hte T esCl,l ahtt neorig n’tsi beign eusd i(scen reteh si no collna paseoxnni or o)esicntel os ’sti tslli tgo het ulfl 6kb lnhget .hunuedtco

d_holles  T lclse illst renoudg DVJ irtobainmnceo ot mofr erhit TsR.C +7  



 +2 
submitted by sam1(22),
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ihWel T cllse od sue eht VJD nircoai,emonbt hte T elcl ecpotrre hsinca rea ernetffid senge frmo the B le'lsc yehva nad thgil anh.cis Scine htye esdu a B llce n-oJgire ,pobre hte T 'sclle bdan illw eb umch rgarel sa htsi eaar fo sit DNA ht(e B llec avyeh or lihgt nhaci gs)nee ahev not eben edrrngaera -- ednasti its T cell etpcrroe egsen heav eenb dagree.nrar






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