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NBME 21 Answers

nbme21/Block 1/Question#17 (reveal difficulty score)
A 7-year-old girl is brought to a clinic in a ...
Methionine πŸ” / πŸ“Ί / 🌳

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submitted by βˆ—lsmarshall(445),
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Aclra inlguteois si otms cmonmo ptye fo lmmaaneo in Acfirna rcnieAams and si on teh asmpl ro ls.oes I usegs het yaltcpi intinhkg fo tehcs dna bkca u(ns oee)xpsd is a lltiet iefrdtenf in siht eytp? mnAog all dapm;rsigcohe ealnmsoam occur hte rmojtaiy fo meit on the blmis (6~3% owlre dan ~19% rpuep;) kntur is .2.~7%. oS dabse on ttah nda hmi nibeg of fArianc denestc ew acn ochoes slpa.m

submitted by βˆ—usmleuser007(438),
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fI uoy n'lctoud mrbmeere wcihh rewe aeltis;nse tneh naatvtereli douwl vahe been to eizarle taht ogrigwn dhlercin eedn cesll to iivedd. sihT qrireuse NAD tanoipcreli and asli.ronnatt Of wihch the ileuncc iadc eymhti is mpain.rott It eisrrueq a thmely eaftrrsn.

Tsih is wehre oniehenitm mcseo in. enioMineth nsboceim hwti TPA to romf ASM (a methyl )ndoro

whossayin  That’s a legendary explanation. Thanks dude! +  
makinallkindzofgainz  This is exactly how I solved it! I remembered that Methionine is essential for methyl transfers, and you would need that in dividing (growing) cells. But now I'll just remember PVT TIM HaLL too :) +2  

submitted by βˆ—nosancuck(93),
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oY gdaw ew all taobu VPT MIT LHLa

lniPn,lheaeany aelnV,i orANytD,TpK nrThino,ee lieIcuns,oe toeMn,hinei niHidest,i encueiL Lneyis

meningitis  I don't understand what the question is asking... can someone please explain it to me? Patient doesnt eat protein, shes chubby. What does methionine have to do with this? +2  
charcot_bouchard  Just basically asking which is essential amino acids. +3  
usmleuser007  Essential amino acids (something i came up with) 1. "Three HAL fans will try meth" a. Threonine = Three b. Histidine; Arginine; Lysine = HAL c. Phenylalanine = fans d. Valine; Isoleucine; Leucine = will e. Tryptophan = try f. Methionine = meth +3  
nala_ula  They're saying there is a lack of good quality protein -> slight nutritional deficiency. She may have acquired weight but it's not because of protein. So they're specifically asking what amino acid she might be missing due to her subpar diet. Since essential amino acids are those that the body cannot make itself, out off those listed, methionine is the essential amino acid. It's on page 81 of FA 2019. +11  
nala_ula  correct me if I'm wrong please :) +  
hello  For anyone confused trying to follow @usmleuser007's comment -- slightly modified Essential amino acids mnemonic "Ah, Three fans will try meth" Ah = arginine, histidine Three = Threonine Fans (phans)= Phenylalanine Vil (Will -- German accent pronouncing English word 'will') = valine, isoleucine, leucine, lysine Try = tryptophan Meth = Methionine +1  
pg32  Why does @hello and @usmleuser007 mnemonic contain arginine? That isn't in the PVT TIM HaLL mnemonic for essential amino acids... +  
paperbackwriter  @pg32 arginine is semi-essential. It is essential in preterm infants who cannot synthesize it +  

submitted by βˆ—usmleuser007(438),
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1. e"eThr AHL afsn will rty 
"thme    .a nnhrTeeoi = reeTh 
    b. itd;sineiH i;Agnerni yniseL = LH
A    c. niynPhnaellea = asnf
    .d l;aneVi oIsinelc;ue uLceine = wl
il    .e opatpyhTrn = yrt
    f. ieenMotnih = 
pparalpha  Thanks! Good mnemonic +1  
b1ackcoffee  best mnemonic +  

submitted by βˆ—usmleuser007(438),
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aesenstil mAnio csaid )A(A

1) usAdlt rruiqee 9 (AA) = laeb ot keam nngreai avi raue e 2)cylc hrdlCnie uqeirer 10 (A)A = tyeh era llsti li3gvoed)n pe itWh UPK sreinyto sboecem nieastels ni hbto lusdat dna dlhrince

submitted by βˆ—drzed(277),
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tsL'e ysa oyu tddi'n wnko oimetnnehi was nstesi.eal

)A( lenaAni -- ouy nca aecter aninlea mfro hte yenmez ATL nnlaaei( rrfnesiea,m)antosa utsh shti eemyzn actnon eb snlisaete

()B ettrapAas -- yuo anc teacre sraptteaa fmro het nezyem STA tsaaatep(r irmsarfoes)nanaet, tuhs htsi eeynmz toncan be asneetils

(C) iyenGlc -- tish one si wlo ieyl,d tbu ti si eadm rfom eeinsr iene(rs + THF tg;&- 2OC + -eFHTM + yng.cle)i If you 'nditd wkno auotb i,sth you adh a 5500/ tsoh

)E( Tiyonser -- ouy cna arecet strneoiy romf aeyinehllnnap lusnse( fo cuseor oyu hvae naionuyt)pe,khlre nda huts tish tnacon eb ssteai.len

submitted by βˆ—hello(384),
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Fro ynoena uenfsodc gntyri ot olowlf msr7el0e@s0'suu ntmmceo

yilglSth dedmoiif

lsEniseta nmaio cdsai nmeonmic "hA, reTeh snfa liwl yrt h"mteeth

Ah = genriin,a hstinidei

eTher = heeTinrno

nsFa (ph)a=ns nnnllPyhaiaee

ilVl lil(w -- arenmG ctacen opgoncniurn hslgEin rowd "lwil)" = einalv, ,ceslinuoie uielc,en nileys

yrT = yrphtoptan

Mhte = itonhenMie

submitted by βˆ—mrglass(42),
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Teh yaw I rreeemmb teh tleesisna inoma dacis si yb eerfigcrnen eth nomia asdic rgsuop I earydal .wnko So eth esniatesl nioam acisd rea:

  1. The naebhcrd icahn aionm i:cads onl,cueIsie niecu,Le dna elinaV

  2. The igredn maoni aiscd ETPEXC roseyTin h(whci scomeeb elssenait ni toesh whti )KUP: hoptnapyTr, e,inHitsdi aynhlniaenleP

  3. hTe uusfrl naincgotni amino saci:d sCinteye and siHinited (uoY illw ees btdeea eorv ewhtreh eeitsnCy euqsfliai sa ntseliaes or ton)

  4. Teh wto oyu stuj vahe ot rem:miezo Tionherne nad nyLeis

mrglass  I meant to say Cysteine and Methionine* +  

submitted by βˆ—saqeer(5),
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a tlitle amileidnsg hre rceaesin ni ghwiet mdae it smee sa fi ehs dha low yihrdto norhmeo adn sotnyeir si a rop.rerscu

b1ackcoffee  but hypothyroidism would decrease the height. +  

submitted by codyluvr95(6),
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B12 escmo mfor tioprne nad is a ancsreyse roocatcf orf onehmeniti owL B21 = wlo oenemni.ith

submitted by βˆ—mcl(641),
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hieMenntio si na ialsetesn nioma aic.d All ehstor setild aer ton.

scalpelofthenorth  Pg 81 Tyrosine is listed as an essential AA. Should be tryptophan for those who got this wrong like me. +  
neonem  But tyrosine can come from phenylalanine, so it's not really essential right? +1  
gh889  in FA2019, it is listed as Tryptophan, not Tyrosine. That was corrected. +16  
usmleuser007  Note: Tyrosine is ONLY essential with PKU in children +  
niboonsh  bro FA2018 lists tyrosine as an essential AA. They played us. +1  

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