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Retired 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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hTe cceonpt si a tudevolocn wya fo skagin fi you enwk ohw VJD bonetrnoamcii wo,ksr cwihh si ahtt ti si acultlya an eleamxp of lnatirge hte AND of hte BT/ tho.cyylepm

thneuorS tblo u:eitcnheq oS nhwe ythe use a rbope tasanig eoms ,ngieor and putingottu a zies of 15. kb or 6 k,b hsit si igllnte uyo hte ezsi of teh DNA traenfgm ni ache lelc (se’tndo mertat fi ehty say J rpebo ro toactnns igoern o,bepr te’eryh tusj gnsayi ’ytereh rgaittneg smoe deunocitle qceeensu dunof in eth Ig lTocu/sRC ateb ahcni uolcs vrptseeciely orf /BT le)ls.c

I kthni the ngonsufci trap uocld eb doinrengw ohw yuo nkow whehert re’you tryapl gutrhho narrtgneeearm reaswn( echcosi B hurt D) ro if ti ahstn’ drcueroc at lal yet c(crerto esw.nar) ereH, hte ccponet si htat B llces unodgre D(JV) rgntrnreaaeme ni eth onbe rr,amow ihlwe T llsce od ti in het y,shutm and it all shpaenp ta c.neo oS a asalpm elcl ni hte lbodo lkie ni lMeltpui oaelmMy wudol evha lyful duegnrnoe ,irooctnamibne whlie a T llec ni hte oodbl culdo ehirte be ullyf decdetau (adn evha ndsiehfi JDV iaon)mtocnierb ro mruimeta tn’has( dtestra D).VJ

cSein eth T lelc ngee swa 6 bk nad nlidietefy gegibr naht eth 1.5 bk eneg, eth T elcl sh’nat edngruone obtcaminrinoe et.y

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trichotillomaniac  eyvr cein atnapl!oiexn +29
nwinkelmann  iThs saw o!esmwea Mead os cumh sesen nda leplyufoh I wlil be labe ot inhtk taht ctcaylilir obtau ouinseqst in het rfuteu (uaebces I VNREE wudlo veha coem up iwht itsh no my onw, a)hh. +5
eacv  O!MG TANHK OU.Y I NDITD NWKO NYTAHNIG obtua !hsit! peHo tish is ont esttdse on laer mnaxee p: +5
ajss  w!wo tsih talexiopann swa e!measwo tnksa!h +
mrglass  lsAo eht llec-T --DVJ tnsemsge rea tno eth asme sa eth lcelB- V-J-D eng.tessm feTherroe a eBlcl- J neemtgs hutrnose bolt odwul ookl for trhehew eth lBl-ce esti DVJ gstenme in a -Tecl,l ihcwh dlouw lwaasy e.or-anarrngden +6
mynamejeff  nTahk yuo! S o si tish scaeueb lpteumli ameyolm pdeorsuc evsxeecis aonoclnlom itglh nhaic ?Ig Is htsi teh .15 kb een?g erhWa,se cels-lT atth avhe tno geno thoghru infeioftteidarn eyt nda etihr J neoigr nuiseldc nervhiyetg V(JD) v.s tsuj VJ ni eth lhtig ich?an AF( 0202 gp 0)41 +
peridot  hTsi atonxpeianl si imanzg!a ovH,reew to luyfl ernutnadsd aoehtrn spte of wath eth inuqotes si gtigten t,a eeapls etak a kolo ta @dboshlidsiwrhrgsaedy'a /dnrao ssrl@am'g xnoeapatlin as wlel - a vrey opamttrin i!oad!ndti +1
skonys  yM giocl wsa ongwr tbu ym enrwas .crctero I am gifefsnru form ceu.sssc +
fhegedus  !wwo iths is ga!nmaiz nktah uy!o +



 +18  upvote downvote
submitted by highyieldboardswards(18)
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tSorh :eransw lAl sgene are rtsepen ni obht B adn T ecl,sl ubt thye earergnra nad pssxree preesrotc atht aer cpeisfic ot hietr l.ngeeai hTrei ear tidnepdeenn VJD sonregi for B ellc ertropec geetaornni dan T elcl rporecet te!naienogr shiT iiwk eritcla sedsh ihglt no sih:t

p:retsiop_no_riiedr.gT#Vwc/ehwmaei)JDt/ctoke.kprsoiai/llt_/cienbn(

I too ygcratlail smside hs..it btu ti is tcayllua so silpem thta ew ear isimsgn eht ofters uhtrhog the reest -hi-el W boht B and T eclsl gnerdou JDV rmaearet,gennr teh V, ,D and J genes are EFINRDTEF ESEGN eiptsed ngibe ageidzorn adn ethoefrre diseisfcal in a laiisrm fonsahi due to trehi rdeahs eedn ot entarege dsvreei rr.uetsutsc oT kame matsetr orem conf,usign obht sste fo DVJ snege rae no oheommcsro 14.

Tihs si hwy the EBNM ificepeds atth yhet rae gtnaggi ETH AMES J RIEOGN chhwi si atth of teh B llce tproerce eegn J oig,ern nto eht T clle cerorept egen te-aJb neiogr ese( wiik .lri)aect eTh B lecl eperocrt eneg is not adrerregan in a T lc,le if ti s,aw T cesll duowl evah etbi!dsoian

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redstrat  T.shi So chmu ti!sh +1



 +5  upvote downvote
submitted by david_bball(5)
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eTh awy I otthghu tobua hsti stioueqn asw thta in MM eterh si a TON fo inasdbteio bigne med,a so teh VDJ negetsm is bnige ekronb nterdd/cespeega/aerrul nmay ismte nda hsa eenb odentrshe ot k.1b5. As ofr the T ,esllC that goenir t’sin ngeib dues (iecns heert is no olacln xeanonpsi or ceiels)otn os ’tsi sltil got het lufl kb6 genhlt oudtuechn.

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d_holles  T slcle iltls rdeougn DVJ ioetrcimbnona to form rihte C.sRT +7



 +2  upvote downvote
submitted by sam1(22)
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leWhi T sllce od esu eth VDJ nrcoio,imeatbn eht T lecl peotrecr ciansh aer effritedn gnsee mfor teh B sl'lec evhya dan hgtli ns.chai inceS yeth sdeu a B elcl -rnigJoe ,opber hte T cl'sel abnd wlli be uhcm leragr sa isth aaer of sit ADN t(he B llec vyhea or hiltg acnhi eg)ens heva not enbe enaerargdr -- siteand ist T lelc rocreetp egesn evha bene g.reaerarnd

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 -5  upvote downvote
submitted by welpdedelp(270)
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pslp:1wro4snbboemoem_n/t/t/nssntiedonrarhttequxb/ptemsppli_tit7_cle.s_ruo2ee_qe2a/d_hi/ecwn/zwm./

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