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WBR0267 + (An ill appearing 52 year old European fema … An ill appearing 52 year old European female presents to the ED with nonspecific complaints like dizziness, nausea and fatigue. Laboratory tests show an anion gap of 13 mEq/L, lactate level of 15.0, pH 7.30 and a normal glucose level, HCO3 17. Detailed history reveals that she is taking oral metformin. Which of the following will apply to this patient’s lactic acidosisll apply to this patient’s lactic acidosis)
WBR0932 + (An investigational drug called Ro 47-0203 … An investigational drug called Ro 47-0203 is being evaluated for the treatment of pulmonary hypertension. Scientists find that in an in-vitro assay measuring the isometric tension of pig aortic rings, Ro 47-0203 is able to induce a potent rightward shift of the concentration-response curve to endothelin-1. However, it has no additional effect when used concurrently with a selective endothelin A antagonist. Which of the following drugs does Ro 47-0203 most likely refer to?rugs does Ro 47-0203 most likely refer to?)
WBR0384 + (An obese 40-year-old woman presents to the … An obese 40-year-old woman presents to the physician's office with complaints of recent headaches, nausea, and vomiting. The patient is found to have elevated opening pressure on lumbar puncture. She is advised to lose weight and is then prescribed a pharmacologic therapy to treat her condition. The patient's prescribed medication is also indicated for which other condition? also indicated for which other condition?)
WBR0329 + (An unconscious 67-year-old man with no adv … An unconscious 67-year-old man with no advance directive is brought to the emergency department by EMS. Following appropriate work-up, the patient is diagnosed with an acute MI and is admitted for appropriate management. Several days later, the physician in charge informs the family that the patient is on life support. The patient has no attorney for healthcare and has no court-appointed legal guardian. When informed, the patient's family members start to discuss among themselves the possibility of taking the patient off life support. His wife states that her husband "would have wanted to stop life support right away". On the other hand, the patient's children and siblings argue that his wife's decision is not in the patient's best interest. They all agree that based on previous decisions made by the patient, "he would do anything to stay alive". The family members ultimately fail to reach a unanimous decision. Which of the following is the most appropriate way to proceed with this patient's case?e way to proceed with this patient's case?)
WBR0683 + (Bacterial antigens are responsible for the stimulation of the innate immune system. Nonetheless, several organisms may evade the body's immunity via antigen variation. Which of the following antigenic variations is true about Salmonella enterica species?)
WBR0029 + (Bifid carotid pulse on physical examination is seen in which of the following?)
WBR0038 + (CG-23 is a bloodborne infectious organism … CG-23 is a bloodborne infectious organism that causes a self-limited acute infection among healthy adults. A group of investigators has developed a new diagnostic test for the detection of a serum marker, TAK, which is a structural component of the CG-23 capsule. A study is evaluating the performance of the new test among 500 healthy subjects who are followed-up for the development of symptoms. Blood is also withdrawn for real-time polymerase chain reaction (RT-PCR) analysis, the gold standard test for the detection of CG-23 DNA. The infectious organism's DNA is detected in 100 individuals by RT-PCR. The sensitivity and specificity of the novel test are 90% and 80%, respectively. What is the probability that a subject with a positive result in the new diagnostic test truly has the disease?new diagnostic test truly has the disease?)
WBR0590 + (Deep brain stimulation (DBS) is an invasiv … Deep brain stimulation (DBS) is an invasive therapeutic procedure indicated for advanced Parkinson's disease. It consists of the surgical implantation of a device that sends high frequency electrical impulses into areas of the basal ganglia, particularly the subthalamic nucleus (STN) and the globus pallidus internus (GPi). It is hypothesized that the mechanism by which DBS improves parkinsonism symptoms includes hyperpolarization in the STN by DBS, which results in a reduction in the subthalamic excitability. Which of the following changes in neurotransmitter release is the result of the reduction in subthalamic excitability?the reduction in subthalamic excitability?)
WBR0393 + (During a minor abdominal surgery, a patien … During a minor abdominal surgery, a patient receives an injection of succinylcholine to facilitate access to the surgical site by paralyzing his abdominal muscles. Several minutes after the injection is administered, the patient's heart rate increases to 135/min and his blood pressure to 182/99 mmHg. The monitor shows an increase in minute ventilation and end-tidal carbon dioxide. His core temperature also begins to increase steadily, reaching 41.2 ᵒC (106.1 ᵒF). Alerted by the patient's status, the anesthesiologist administers an intravenous agent to counteract the effects of the muscle relaxant. The patient's vitals slowly begin to stabilize. Which of the following intravenous agents did the anesthesiologist most likely administer to the patient?ist most likely administer to the patient?)
WBR0075 + (During a routine checkup, a 33-year-old wo … During a routine checkup, a 33-year-old woman is noted to have an elevated blood pressure of 180/120 mmHg and mild headache. She denies the presence of chest pain, shortness of breath, or frothy urine. Her thyroid-stimulating hormone, cortisol, and 24-hour urinary excretion of catecholamines are all within normal range. However, there is a string-of-beads appearance on an angiogram of her left renal artery. Which of the following pathologic findings is most likely to be observed from the lesional biopsy?y to be observed from the lesional biopsy?)
WBR0115 + (During an outbreak of an infectious diseas … During an outbreak of an infectious disease, a 30-year-old man presents to the emergency department with fever for the past 2 days. He complains that he has diffuse body aches with myalgia and loss of appetite. Further history-taking reveals that the patient was recently bitten by a ''Culex'' mosquito. The patient's blood pressure is 110/84 mmHg, heart rate is 102/min, and temperature is 38.4 °C (101.12 °F). Physical examination, including neurological exam, is unremarkable. The physician suspects the patient might be infected by an agent that has also infected bird species in the same district. Which of the following best characterizes the infectious agent responsible for this patient's condition? responsible for this patient's condition?)
WBR0337 + (During development, in-utero testosterone … During development, in-utero testosterone secretion by the testes act directly on the Wolffian ducts and play an important role in the differentiation of external and internal male organs. Similarly, dihydrotestosterone (DHT), a more potent androgen derived from testosterone by the action of 5-alpha-reductase, is also involved in the differentiation of male organs. Which of the following processes is a function of DHT? following processes is a function of DHT?)
WBR0908 + (Elevated levels of galactose are detected … Elevated levels of galactose are detected in a newborn screening test and prompt further investigation for a galactose metabolism disorder. An erythrocyte enzyme assay that monitors the accumulation of products of the galactose metabolic pathway following the addition of a radiolabeled substrate is carried out. The enzyme assay confirms the diagnosis of a galactose metabolism disorder that leads to mental retardation, failure to thrive, and jaundice if galactose is not eliminated from the diet. Which of the following is most likely the result of the enzyme assay in this patient?esult of the enzyme assay in this patient?)
WBR0580 + (Experimental studies suggest that age-rela … Experimental studies suggest that age-related dementia may be caused by chronic cerebral ischemia that results from decreased cerebral perfusion. A new investigational drug is being evaluated for its possible role in the prevention of dementia. Cerebral perfusion studies during non-stressful events are performed following the administration of the investigational drug. Studies reveal vasodilation of the cerebral arteries. The vasodilation observed following the administration of the drug is similar to that of which of the following physiological mechanism? of the following physiological mechanism?)
WBR0265 + (Following a large explosion at a construct … Following a large explosion at a construction site during excavation, its workers are brought to the ER. While examining them none appear to be injured. But some were diagnosed with hearing loss following the explosion. They were exposed to sound pressure levels of 190 dB. Which of the following is the most likely type of hearing lossng is the most likely type of hearing loss)
WBR0316 + (Following delivery, a 28-year-old woman st … Following delivery, a 28-year-old woman states that her newborn boy is continuously dripping urine. On physical examination, the pediatrician notes the newborn has an abnormal opening of the penile urethra on the dorsal side of his penis. When asked, the physician explains that the condition is caused by the faulty positioning of the genital tubercle during development and states that the patient will require surgical management. Which of the following conditions is this patient's most likely diagnosis?s is this patient's most likely diagnosis?)
WBR1013 + (Hemodynamic parameters are collected from … Hemodynamic parameters are collected from the medical records of hospitalized patients with different medical conditions for a retrospective study. One of the patients has the following parameters: Systolic blood pressure: 160 mmHg Diastolic blood pressure: 60 mmHg Pulse: 102 beats per minute Which of the following diseases is associated with the patient's hemodynamic parameters? diseases is associated with the patient's hemodynamic parameters?)
WBR1943 + (Here is a prompt)
WBR0341 + (Human Immunodeficiency Virus (HIV) is a sp … Human Immunodeficiency Virus (HIV) is a spherical retrovirus surrounded by an envelope composed of a phospholipid bilayer. It is a diploid virus composed of positive single-stranded RNA that codes for 9 viral genes. Two proteins on the surface of the viral envelope are derived from the ''env'' gene, which is essential for viral tropism. Which of the following proteins are required for viral attachment to host T-cell and entry, respectively?nt to host T-cell and entry, respectively?)
WBR0481 + (In a quest to find the ultimate low densit … In a quest to find the ultimate low density liproprotein cholesterol (LDL-C) lowering drug for the treatment of heterozygous familial hypercholesterolemia, researchers have discovered an endogenous substance, Proprotein convertase subtilisin/kexin type 9 (PCSK9), which acts by binding to the epidermal growth factor-like repeat A (EGF-A) domain of the low-density lipoprotein receptor (LDLR). It was also postulated that developing monoclonal antibodies against this compound will have a tremendous effect in lowering the level of LDL-cholesterol in this group of patients.Which of the following mechanisms of action best describes this experimental drug?ion best describes this experimental drug?)
WBR0971 + (In an experiment, liver mitochondrial subf … In an experiment, liver mitochondrial subfractions are purified from sample of bovine livers, and mitochondrial enzymes involved in the urea cycle are isolated. Fatty acylation assays are then carried out on the samples in order to study the regulatory role of fatty acylation in the kinetic activity of these enzymes. Which of the following enzymes is most likely present in the purified mitochondrial sample?sent in the purified mitochondrial sample?)
WBR0340 + (In order to study cellular responses, a st … In order to study cellular responses, a student exposes two groups of mice to an influenza virus infection: A control group with intact bone marrow and another group with completely ablated bone marrow. The student observes that in the control group, concentrations of an intracellular protein (Protein A) in muscle cells rise in parallel with the intracellular activity of 2'-5′ oligoadenylate synthetase and the serum concentration of IFN-α/β. In contrast, the influenza viral load is much more elevated in the group with the ablated bone marrow, while no rise in protein A concentrations is observed. Which of the following is the most likely function of protein A? is the most likely function of protein A?)

WBR0028 + (Kussmaul’s sign is seen in which of the following?)

WBR0935 + (Lenalidomide is a highly effective chemoth … Lenalidomide is a highly effective chemotherapeutic agent against multiple myeloma. A scientist is investigating the anti-neoplatic mechanism of lenalidomide. She finds that addition of lenalidomide to multiple myeloma cells decreases the protein abundance of the plasma cell essential transcription factors IKZF1 and IKZF3. She finds that lenalidomide binds to the CRBN-CRL4 complex, which then induces a post-translational modification of IKZF1 and IKZF3. Which of the following enzymatic activities does CRBN-CRL4 most likely possess?vities does CRBN-CRL4 most likely possess?)
WBR0141 + (Neutrophils are critically involved in the … Neutrophils are critically involved in the process of inflammation. The sequence of events in the recruitment of neutrophils from the vessel lumen to the stromal compartment is called extravasation, which can be divided into four major steps. Which of the following signaling mediators is involved in the migration of neutrophils across endothelial cells?n of neutrophils across endothelial cells?)
WBR1142 + (On examination physician notices a horizon … On examination physician notices a horizontal scar in front of the neck. His vitals are as follows,BP 138/88 mm of HgPulse 98b/mTemperature 99FHis systemic examination is otherwise normal, except hypereflexia in all four extremities. What is the next best step in the management of osteoporosis?st step in the management of osteoporosis?)
WBR0763 + (Osteogenesis is a complex process that res … Osteogenesis is a complex process that results in the development of bone. Intramembranous and endochondral ossification are 2 processes that result in osteogenesis. Both processes are similar in their conversion of a pre-existing tissue into bone. However, intramembranous and endochondral ossification differ greatly in the means to form bone. Which of the following statements is true regarding osteogenesis?statements is true regarding osteogenesis?)
WBR277 + (Physician is called to see a newborn in th … Physician is called to see a newborn in the nursery because the nurse is concerned that the baby have single crease in the palm of the hand, small ears, small mouth, upward slanting eyes, wide space between the first and second toes, short hands with short fingers. Which of the following sign is most likely associated in this newborn?is most likely associated in this newborn?)
WBR0555 + (The "HDL hypothesis" suggests that high de … The "HDL hypothesis" suggests that high density lipoprotein-cholesterol (HDL-C) is inversely associated with atherosclerosis, and HDL-C has a protective role against cardiovascular disease. What is the main mechanism involved in the anti-atherogenic properties of HDL-C? the anti-atherogenic properties of HDL-C?)
WBR0682 + (The anal canal is a unique anatomic region … The anal canal is a unique anatomic region that is characterized by blood supply and lymphatic drainage from two different origins. While the lower rectum and the upper part of the anal canal above the pectinate line share the internal iliac as the primary lymph node drainage site, which of the following structures shares the same primary lymph node drainage site as that of the lower part of the anal canal below the pectinate line?f the anal canal below the pectinate line?)
WBR0484 + (The innate immune system includes a variet … The innate immune system includes a variety of cell types that act as a primary response to infection. One major player in the innate immune system harbors a key protective component known as major basic protein and is induced to proliferate in the presence of IL-5. Which of the following cellular functions also correlates with the cell described above? correlates with the cell described above?)
WBR0401 + (The mechanism of action of a novel experim … The mechanism of action of a novel experimental drug is under investigation. The drug is intended to treat patients with atrial and ventricular arrhythmias who cannot tolerate other therapies. After initial rat testing, the core lab determines that the active molecule acts on the trans-membrane proteins that regulates the resting membrane potential of cardiomyocytes. ECG monitoring demonstrates significant, dose-dependent increase in the QT interval in treated rats. Which of the following drugs has a mechanism of action similar to the experimental drug being evaluated? to the experimental drug being evaluated?)
WBR1133 + (The parents of a 7-year-old boy divorce. … The parents of a 7-year-old boy divorce. The boy lives with the mother and sees his father every-other weekend. During these visits, the boy is sullen and angry with the father, but when it is time to return home, he clings to the father and cries in a desperate manner while saying "I'm sorry! I want you and mom to live together forever." This is an example of,together forever." This is an example of,)
WBR1128 + (The patient has an absolute right to his p … The patient has an absolute right to his privacy. It’s a physician’s duty to respect this privacy and not share health information with anyone, including patient's family, colleagues or other parties. This is known as the principle of confidentiality. In which of the following cases is a physician legally bound to overlook this principle? legally bound to overlook this principle?)
WBR261 + (The patient is a 72-year-old man brought t … The patient is a 72-year-old man brought to the primary care clinic by his family over concerns that he has Alzheimer's disease. They have noticed a worsening of his memory over the past 6 months. He does not seem to want to get out of bed, and he appears to have difficulty providing for his basic needs such as cleaning, dressing, and cooking for himself. He is hesitant when talking, but it is unclear whether he is unable or unmotivated to speak. His family has also noticed that he appears depressed and is often seen crying. A MSE of the patient is performed to help determine whether he is suffering from a dementing illness or a depressive illness (pseudodementia).Further history, cognitive examinations, physical examination, and laboratory/radiographic studies are obtained. The results are consistent with Alzheimer's dementia. While the family had been able to take care of him initially, they have since returned to the clinic stating that they can no longer keep him at home. They feel that he is becoming much more agitated. He is staying up at night. Lately he has been rearranging the furniture, claiming to look for "the little people who are teasing me." They have noticed that he has difficulty walking, often moving slowly and dropping items. The family has pursued nursing home placement, but they wish to have something prescribed in order to help him sleep and keep him calm.Which of the following medications should be avoided in this patient?cations should be avoided in this patient?)
WBR1143 + (The patient is moving to Nepal for next 4 years, which of the following tests you will recommend to follow up with a new primary care doctor?)
WBR262 + (The police bring a 22-year-old male into t … The police bring a 22-year-old male into the emergency room after a disruption at the local college campus. According to his medical chart, he has been treated for a depressive episode in the past. He describes his mood as "great" but claims to have been awake for 4 days due to working on several inventions. He admits to rapid thoughts and believes that God has chosen him to be the next Messiah. In fact, angels have commanded him to steal from the student union in order to begin a new church.Urine toxicology performed in order to rule out a substance of abuse as a cause of his symptoms would most likely reveal which substance? would most likely reveal which substance?)
WBR266 + (The police bring a 22-year-old male into t … The police bring a 22-year-old male into the emergency room after a disruption at the local college campus. According to his medical chart, he has been treated for a depressive episode in the past. He describes his mood as "great" but claims to have been awake for 4 days due to working on several inventions. He admits to rapid thoughts and believes that God has chosen him to be the next Messiah. In fact, angels have commanded him to steal from the student union in order to begin a new church. Which of the following drugs should be given to treat symptoms of this patient?e given to treat symptoms of this patient?)
WBR0000 + (This is a test.)
WBR0529 + (To study the effects of a newly developed … To study the effects of a newly developed drug, a researcher uses polarized microscopy to monitor the changes in living Pectinaria oocytes exposed to intermittent doses of this agent. Although most oocytes are not directly affected, those in active replication seem to arrest at a certain point during mitosis with a significant reduction in the size of meiotic spindles, as measured by loss of birefringence under polarized light. The researcher also notices that shortly after the drug is washed, mitosis would resume and the spindles would regain birefringence. Which of the following drugs most likely has the same mechanism of action?t likely has the same mechanism of action?)
WBR0147 + (Two medical teams are conducting identical … Two medical teams are conducting identical studies that aim to detect an association between vitamin K deficiency and osteoporosis in France and Russia. Both teams are using the same test kit that is designed to measure vitamin K concentration in the blood. The sensitivity of the test is 90% and its specificity is 85%. According to previous studies, the prevalence of vitamin K deficiency is higher in Russia than it is in France. Based on the previous information, which of the following statements is correct?ch of the following statements is correct?)
WBR0342 + (Viral hepatitis is a prevalent infectious … Viral hepatitis is a prevalent infectious disease that is associated with significant worldwide morbidity and mortality. Despite being a relatively common disease, prognosis differs greatly and depends on the host immunity, viral type, and strain. Which of the following viral type and host combinations is associated with a high mortality rate? is associated with a high mortality rate?)
WBR0027 + (What is the most common cardiac manifestation of HIV?)
WBR0060 + ( A 34-year-old woman presents to her physi …  A 34-year-old woman presents to her physician's office complaining of a rash that started on her palms and soles but has begun spreading to her wrists and ankles. She has recently also been experiencing new-onset headaches, malaise, and progressive fever. Her past medical history is unremarkable. She has no known allergies to food or medications. She does not drink alcohol or smoke, but is sexually active. She reports no history of international travel, but recently returned from a vacation in Boston. What is the optimal treatment for this patient's condition?al treatment for this patient's condition?)

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