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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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 +79 
submitted by aishu007(4),
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ietslEnvoa ni dboy urtrteeemap coruc newh tnaeotconncris fo alioprndsngta 2)E( E(GP)2)( icnerase thniwi ienratc sreaa of eth aeiesnrbh.T linsveeoat lerat het ingrif etar of soerunn tath rcooltn armnotieheutorgl in eth .aosmplhyhua.t tI si nwo recla that msot cnytriseaipt krwo by ibhngntiii hte eyznem nxecocoygalsye and ciugdern eht lesevl of (PGE2) iwinth teh aohlatyshup.m

1n1ewocil5:mw6psb6w/tn/.mnv1h./i6.p/t4ghu.bd


 +70 
submitted by sacredazn(101),
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ehT enptcoc is a dtleoovunc way fo igansk fi yuo kwen owh DJV aooeticnnbrmi wk,ors hichw si taht it is ulaytcla an lepaxme fo ralignte eth NAD fo eht TB/ y.mhopetlcy

Senotruh oblt cetq:nuieh So wenh yhte seu a bepor isagtan omse egiron, nad ituntpguto a isez fo 15. kb ro 6 bk, siht si tiellng yuo the eisz of teh DNA mteagnrf in ceha lcel n’etos(d eamrtt if eyth ysa J eobpr ro noacstnt roiegn robe,p eerhy’t utjs gysnai rt’ehey gnegtiatr smeo otdceiulen csnueeqe dnuof in hte gI oc/CuslTR abte anihc uclso eterlescyvip orf T/B sc)ell.

I tnihk eth ucoingfsn atpr uoldc be nigeronwd who ouy nkwo whrhtee yo’ure rptyal ogruthh eeretanrrmang sa(rnwe iescohc B hurt D) or if it h’tnas ruoeccrd ta lal tey rrcto(ec r.asnwe) ,erHe eth pccneot si atth B llsec ngurdeo )VJ(D taaemneerrngr ni hte bnoe wrrmao, whlie T slelc od ti ni teh musth,y nda ti all phasnep at enoc. So a slmaap cell ni eth obdlo ilek ni iteMlpul meoMlay dlwou veha lflyu donuenrge iib,cntnaromeo wheli a T lcel ni hte obold ocldu threei be lulyf ueetddca n(da ahve ishidnef DJV toainmc)ebnrio or umirmtae ’sn(hat atrtsde )D.JV

ineSc het T lcel eeng saw 6 bk nda eydelitnif rgbgie tanh het .15 kb ,egen teh T lelc asht’n reogudnen nnbaeirticmoo ey.t

trichotillomaniac  yvre cnie x!ltnapenoai +29  
nwinkelmann  Tsih swa oesmwa!e eMda os uchm seens nda yphlloefu I iwll be bael to kniht ttah ctayirclli btaou enqusiots ni eth fteruu seu(baec I VEERN owdlu ehva moec up hwit tshi on my ow,n a.h)h +5  
eacv  OGM! KHTAN UYO. I NTDDI ONKW INTGANYH btoau t!h!si Hoep ihts is not seedstt no lrae examen p: +5  
ajss  ow!w tihs axatoelpinn aws w!seaoem !hskant +  
mrglass  losA eth cll-Te D-JV- esgetmsn ear ont hte easm as eht lB-lec -D-VJ temsnsg.e efreehoTr a cBlel- J nemstge ostrnuhe lobt lduow loko rof hheewtr eht lBl-ec esti JDV gtenmes in a ,Telc-l iwhch lwduo wsayla earnargedonn.r- +6  
mynamejeff  nTahk you! So si ihts eucasbe pllemtui elamomy opseucdr ixeeevssc oaolclonmn iltgh naich ?Ig sI shti eth .51 bk egn?e ar,Weesh seTcll- taht veha nto engo horhtug arnttenffediioi tye nda erhit J inogre cildnesu ivetrgehny V)(JD s.v tsuj VJ in eht thlgi naci?h FA( 2002 gp 0)41 +  
peridot  hisT napixlaoent is a!mngaiz H,oeevwr to fulyl nedtdsuran thaeonr tspe of what hte tueqoins si ngtiteg ta, ealesp eatk a oklo at ilhsgab@dhery'odsdiswra d/nora rl'g@asms xeptnlnoiaa sa lelw - a eryv ntmorpait id!ontad!i +1  
skonys  yM glioc aws rgnow but my enrswa trr.occe I ma nufirfesg omfr sesccsu. +  
fhegedus  ow!w itsh si gmanza!i kahtn !oyu +  



 +18 
submitted by highyieldboardswards(18),
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rShto ean:swr All gnsee era epesrnt in bhot B dna T lslc,e btu hyte ararnrege adn rssxeep rcpesrote that rae isceicpf to hteri linage.e Tiher rae dedpnenntie DJV rsgioen ofr B ellc ropcrete intngoeear nda T clle crrpeoet gnaeeo!ntir hTsi kiiw rieltac sshed lihgt no hts:i

_atleooVpep..i)wiot_kirr/dn#iicbiec/skmrn/e:/Jpt(DesaeohgTr_wniltc

I oot yaliacrlgt ssdeim i.hst. tbu it is lluatcay os esmilp that we era isngmis eht ortefs ghotruh the etres -ei-l hW othb B nda T escll grudone JVD re,nrtagemenra teh V, D, nad J esnge aer NFTEEDFRI SNEGE dsteipe ibegn eorgnzdia nda otherfeer ifsecasild in a riimlas ofihsan due ot hriet ahrdes eend ot enratgee seedvir t.rsseuruct To emak mtratse rmeo g,iucfsnon btho sset of VDJ eegns are on rmhsoeomoc 14.

isTh si hyw teh NEBM epcisifed atht htye are igagngt THE SMAE J EGONRI whhci is thta of eht B lcel rperoetc egne J ,oierng tno hte T ellc rrcopete egen Jtb-ae goiner ee(s iikw aci).rlet heT B llec rprcetoe eegn si otn engaderarr ni a T cell, if it s,aw T lcles dulwo hvea dosbinet!ia

redstrat  ih.Ts So uhcm !ihts +1  



 +5 
submitted by david_bball(5),
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ehT way I hotgthu abotu isth eqnostui saw ttah ni MM hrtee si a TNO fo adsenoitib enbig daem, os hte JVD megsetn si nbegi kbnore rnrceeg/aeelts/peadurd yanm etism nad hsa nebe tdoenrhes ot 5..b1k sA ofr eht T e,slCl hatt onireg is’tn bngie dsue inc(se tereh is on lcnalo exnnsoipa ro scietone)l so ti’s tsill got hte fllu 6kb tehgln duohtunec.

d_holles  T clsel ltlsi gerdonu DJV ctneiobmnioar ot form rheti sT.CR +7  



 +2 
submitted by sam1(22),
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Wleih T celsl do ues het JVD m,earocintinbo hte T lcle ropercte nashci era idfeeftrn gsene romf het B el'scl ahevy nda lgtih .cnahsi ecniS hyte udes a B lelc -rnogJei ,robep the T 'leslc nbad illw be mchu lrerag as isht aear of sit DAN e(ht B lelc yveha or hltig inhca gse)en hvae tno nbee ergdanrrea -- dsntaei sti T lelc rtcerpoe ngese aveh eenb arerer.andg






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