Page 1 of 81
WGU D118 OBJECTIVE ASSESSMENT FINAL 2024 ACTUAL
EXAM 300 QUESTIONS AND CORRECT DETAILED ANSWERS
A 45 year old patient with a history of alcohol use disorder has developed weakness, fatigue,
loss of appetite, weight loss and physical exam reveals ascites, hepatosplenomegaly, spider
nevi, clubbing, and dupuytren contracture. His ALT/AST ratio is 2.7 and hemoglobin is 8.8
mg/dL. His MCV is 104 and ultrasonography detects nodularity and increased echogenicity of
the liver. Which of the following would confirm a diagnosis of the suspected condition in this
patient?
A. Scleral icterus
B. Hyperbilirubinemia
C. Biopsy of the liver tissue
D. Elevated prothrombin time - ANSWER>>C. Biopsy of the liver tissue. Rationale: a liver biopsy
is required to confirm cirrhosis . elevated LFTs, bilirubin and decreased albumin are indicative of
cirrhosis but not confirmatory. predictors of cirrhosis are ascites, platelet count less than
160,000 mm3, spider angiomata, and bonacini cirrhosis discriminant score greater than 7.
A 38-year-old woman presents to the clinic with a painful, tender keratinized lesion on the sole
of her right foot. She says that the lesion developed two months ago and is slowly enlarging.
She now has difficulty bearing weight on her affected foot. Her past medical history is
significant for type II diabetes mellitus managed on rosiglitazone. Her last menstrual period was
three weeks ago. She is sexually active with three partners, and inconsistently uses condoms.
Vital signs are within normal limits. The examination of the foot shows a hyperkeratotic lesion
with a dark center. The palpation of the lesion causes immense pain. What cancer is linked with
the etiology of this lesion?
A. Basal Cell Carcinoma
B. Melanoma
C. Cervical Cancer
D. Burkitt's lymphoma - ANSWER>>C. Cervical Cancer. Rationale: This lesion is most likely a
plantar wart. However, with skin contact, the HPV can be transferred to any part of the body.
1
,Page 2 of 81
HPV tends to cause genital warts, flat warts, and palmoplantar warts. Warts are easily
transmitted by direct or indirect contact, especially if there is a disruption of the normal
epithelial barrier. • Plantar warts are caused by human papillomaviruses (HPV). • HPV
serotypes 16 and 18 are associated with carcinogenesis. Malignant transformation usually is
seen in patients with genital warts and immunocompromised patients. • Cervical cancers are
most commonly attributed to genital infections with HPV serotypes 16 and 18.
A 58-year-old man presented to the hospital with right-sided decreased hearing for two years.
His wife mentions he has started snoring recently. He has been a smoker for the last 25 years
and smokes up to 20 cigarettes/day. The provider decides to perform a nasendoscopy. Which
key anatomical area is the pathology most likely to be situated in?
A. Right Middle Meatus
B. The roof of the nasal cavity
C. Right vallecula
D. Postnasal space - ANSWER>>D. Postnasal space. In a patient with recent-onset unilateral
hearing loss and nasal obstruction with a social history of smoking one must rule out a
nasopharyngeal pathology most likely a malignancy. • Any mass in the nasopharynx can
obstruct the medial ends of the eustachian tube leading to problems with the ears. •
Nasopharyngeal cancer can arise from the fossa of Rosenmüller, which lies behind the
eustachian tubes on either side. So a clear look at this area with a nasendoscopy in high-risk
patients with unilateral middle ear effusion is mandatory. • Malignancies in the other
anatomical areas mentioned are obviously possible, but will not cause unilateral middle ear
effusion with conductive hearing loss.
A 49-year-old woman admitted to the hospital complaining of severe kidney injury after being
stabbed by a thief. She was diagnosed with acute kidney failure and was referred to the
hemodialysis center. Later on, she decided to undergo a kidney transplantation procedure.
After the procedure was done, the doctor prescribed cyclosporine for her as prophylaxis to
avoid organ rejection. Still, after a month, she came to the hospital complaining of some flu-like
symptoms and fever. The doctor noticed that the previously prescribed drug is not efficient in
reducing immunity. What is the next preferred step to avoid rejection?
2
,Page 3 of 81
A. Prescribe tacrolimus
B. Increase the dose of cyclosporine
C. Prescribe amoxicillin
D. Prescribe paracetamol - ANSWER>>A. Rationale: Tacrolimus is efficient more than ten folds
when compared to cyclosporine. • Calcineurin inhibitors' dosages should be monitored
cautiously as an increase in its blood concentration could cause many complications like kidney
failure. • Cyclosporine, tacrolimus, and pimecrolimus are called calcineurin inhibitors because
they inhibit the enzyme "calcineurin" that is responsible for T-cell activation. • Tacrolimus is
used as an adjuvant to other immunosuppressive drugs to avoid organ rejection.
A 28-year-old primigravida presented to the antenatal clinic for a routine check-up. She has
been exposed to someone with chickenpox but has not developed any skin lesions. She has no
varicella-zoster antibodies. What would be the best possible treatment for her?
A. Chickenpox vaccine
B. Immunoglobulins
C. Antivirals
D. No medication is required - ANSWER>>B. Immunoglobulins. Rationale: An
immunocompromised patient, when exposed to someone with chickenpox, is given
immunoglobulins unless he develops the disease. • An immunocompromised patient, when
exposed to someone with chickenpox, is given antivirals when he develops the disease. • When
a pregnant patient is exposed to someone with chickenpox, and she has not developed the
disease. Her varicella-zoster antibodies are checked. If she has antibodies, no further treatment
is required. • If a pregnant patient is exposed to someone with chickenpox and she has
developed skin lesions, then antivirals are given.
A 55-year-old male with a 75 pack-year history of smoking presents to the clinic to establish
primary care and discuss age-appropriate screening options for cancer. His pulse rate is 78/min,
blood pressure is 140/80 mmHg, and saturation at room air is 96%. Air entry is decreased
bilaterally with occasional rhonchi and crepitations on chest auscultation. He is advised by the
primary care provider to undergo a low dose CT scan (LDCT) for screening. Which of the
following are the criteria for undergoing this screening test for this patient?
3
, Page 4 of 81
A. All adults between ages 55 and 80 years
B. Adults more than 40 years of age with a 20 pack-year smoking history
C. Adults aged 55 to 80 years with a 30 pack-year smoking history
D. Adults less than 60 years of age who are active smokers and have no other risk factors -
ANSWER>>C. Recommendations are for patients more than 55 years of age with an additional
risk factor such as family history, occupational exposure to carcinogens, or personal history of
chronic obstructive pulmonary disease (COPD). According to the National Lung Screening Trial,
patients aged 55 to 80 years with a 30 pack-year history of smoking who are active smokers or
quit within the last 15 years qualify for annual low-dose CT screening. Patients with a life-
limiting condition should not be screened.
A preventative medicine task force is trying to identify and combat peripheral arterial disease
among the rural population they serve. They seek information regarding a rapid, low cost, and
sensitive tool to detect this disease that can be used at health fairs scheduled to take place in
the rural town centers. Which of the following would be the best screening tool for this
situation?
A. Doppler ultrasound
B. 5-minute treadmill test
C. Ankle-brachial pressure index (ABI)
D. Pedal pulse palpation - ANSWER>>D. Pedal pulse palpation. In a study of over 18,000 men,
the presence of bilateral dorsalis pedis and posterior tibial pulses ruled out peripheral arterial
disease (PAD) with enough reliability for the authors to conclude it could be used as an
appropriate initial screening tool for PAD. In order for pedal pulse palpation (PPP) to effectively
screen for PAD, if any of the 4 pedal pulses are absent, the patient should be referred to a
primary care provider to receive ABI testing for PAD, which is a more specific tool. ABI testing,
which involves calculating a pressure ratio between the ankle and arm blood pressure, involves
specific training and equipment. Although it is often used as an initial test for PAD in the office
setting with one clinician and patient, at a health fair where rapid low cost, low equipment
screening is needed, there is a better option. PAD is common at the population level, with
estimates of around 10% prevalence in adults over 55.
4
WGU D118 OBJECTIVE ASSESSMENT FINAL 2024 ACTUAL
EXAM 300 QUESTIONS AND CORRECT DETAILED ANSWERS
A 45 year old patient with a history of alcohol use disorder has developed weakness, fatigue,
loss of appetite, weight loss and physical exam reveals ascites, hepatosplenomegaly, spider
nevi, clubbing, and dupuytren contracture. His ALT/AST ratio is 2.7 and hemoglobin is 8.8
mg/dL. His MCV is 104 and ultrasonography detects nodularity and increased echogenicity of
the liver. Which of the following would confirm a diagnosis of the suspected condition in this
patient?
A. Scleral icterus
B. Hyperbilirubinemia
C. Biopsy of the liver tissue
D. Elevated prothrombin time - ANSWER>>C. Biopsy of the liver tissue. Rationale: a liver biopsy
is required to confirm cirrhosis . elevated LFTs, bilirubin and decreased albumin are indicative of
cirrhosis but not confirmatory. predictors of cirrhosis are ascites, platelet count less than
160,000 mm3, spider angiomata, and bonacini cirrhosis discriminant score greater than 7.
A 38-year-old woman presents to the clinic with a painful, tender keratinized lesion on the sole
of her right foot. She says that the lesion developed two months ago and is slowly enlarging.
She now has difficulty bearing weight on her affected foot. Her past medical history is
significant for type II diabetes mellitus managed on rosiglitazone. Her last menstrual period was
three weeks ago. She is sexually active with three partners, and inconsistently uses condoms.
Vital signs are within normal limits. The examination of the foot shows a hyperkeratotic lesion
with a dark center. The palpation of the lesion causes immense pain. What cancer is linked with
the etiology of this lesion?
A. Basal Cell Carcinoma
B. Melanoma
C. Cervical Cancer
D. Burkitt's lymphoma - ANSWER>>C. Cervical Cancer. Rationale: This lesion is most likely a
plantar wart. However, with skin contact, the HPV can be transferred to any part of the body.
1
,Page 2 of 81
HPV tends to cause genital warts, flat warts, and palmoplantar warts. Warts are easily
transmitted by direct or indirect contact, especially if there is a disruption of the normal
epithelial barrier. • Plantar warts are caused by human papillomaviruses (HPV). • HPV
serotypes 16 and 18 are associated with carcinogenesis. Malignant transformation usually is
seen in patients with genital warts and immunocompromised patients. • Cervical cancers are
most commonly attributed to genital infections with HPV serotypes 16 and 18.
A 58-year-old man presented to the hospital with right-sided decreased hearing for two years.
His wife mentions he has started snoring recently. He has been a smoker for the last 25 years
and smokes up to 20 cigarettes/day. The provider decides to perform a nasendoscopy. Which
key anatomical area is the pathology most likely to be situated in?
A. Right Middle Meatus
B. The roof of the nasal cavity
C. Right vallecula
D. Postnasal space - ANSWER>>D. Postnasal space. In a patient with recent-onset unilateral
hearing loss and nasal obstruction with a social history of smoking one must rule out a
nasopharyngeal pathology most likely a malignancy. • Any mass in the nasopharynx can
obstruct the medial ends of the eustachian tube leading to problems with the ears. •
Nasopharyngeal cancer can arise from the fossa of Rosenmüller, which lies behind the
eustachian tubes on either side. So a clear look at this area with a nasendoscopy in high-risk
patients with unilateral middle ear effusion is mandatory. • Malignancies in the other
anatomical areas mentioned are obviously possible, but will not cause unilateral middle ear
effusion with conductive hearing loss.
A 49-year-old woman admitted to the hospital complaining of severe kidney injury after being
stabbed by a thief. She was diagnosed with acute kidney failure and was referred to the
hemodialysis center. Later on, she decided to undergo a kidney transplantation procedure.
After the procedure was done, the doctor prescribed cyclosporine for her as prophylaxis to
avoid organ rejection. Still, after a month, she came to the hospital complaining of some flu-like
symptoms and fever. The doctor noticed that the previously prescribed drug is not efficient in
reducing immunity. What is the next preferred step to avoid rejection?
2
,Page 3 of 81
A. Prescribe tacrolimus
B. Increase the dose of cyclosporine
C. Prescribe amoxicillin
D. Prescribe paracetamol - ANSWER>>A. Rationale: Tacrolimus is efficient more than ten folds
when compared to cyclosporine. • Calcineurin inhibitors' dosages should be monitored
cautiously as an increase in its blood concentration could cause many complications like kidney
failure. • Cyclosporine, tacrolimus, and pimecrolimus are called calcineurin inhibitors because
they inhibit the enzyme "calcineurin" that is responsible for T-cell activation. • Tacrolimus is
used as an adjuvant to other immunosuppressive drugs to avoid organ rejection.
A 28-year-old primigravida presented to the antenatal clinic for a routine check-up. She has
been exposed to someone with chickenpox but has not developed any skin lesions. She has no
varicella-zoster antibodies. What would be the best possible treatment for her?
A. Chickenpox vaccine
B. Immunoglobulins
C. Antivirals
D. No medication is required - ANSWER>>B. Immunoglobulins. Rationale: An
immunocompromised patient, when exposed to someone with chickenpox, is given
immunoglobulins unless he develops the disease. • An immunocompromised patient, when
exposed to someone with chickenpox, is given antivirals when he develops the disease. • When
a pregnant patient is exposed to someone with chickenpox, and she has not developed the
disease. Her varicella-zoster antibodies are checked. If she has antibodies, no further treatment
is required. • If a pregnant patient is exposed to someone with chickenpox and she has
developed skin lesions, then antivirals are given.
A 55-year-old male with a 75 pack-year history of smoking presents to the clinic to establish
primary care and discuss age-appropriate screening options for cancer. His pulse rate is 78/min,
blood pressure is 140/80 mmHg, and saturation at room air is 96%. Air entry is decreased
bilaterally with occasional rhonchi and crepitations on chest auscultation. He is advised by the
primary care provider to undergo a low dose CT scan (LDCT) for screening. Which of the
following are the criteria for undergoing this screening test for this patient?
3
, Page 4 of 81
A. All adults between ages 55 and 80 years
B. Adults more than 40 years of age with a 20 pack-year smoking history
C. Adults aged 55 to 80 years with a 30 pack-year smoking history
D. Adults less than 60 years of age who are active smokers and have no other risk factors -
ANSWER>>C. Recommendations are for patients more than 55 years of age with an additional
risk factor such as family history, occupational exposure to carcinogens, or personal history of
chronic obstructive pulmonary disease (COPD). According to the National Lung Screening Trial,
patients aged 55 to 80 years with a 30 pack-year history of smoking who are active smokers or
quit within the last 15 years qualify for annual low-dose CT screening. Patients with a life-
limiting condition should not be screened.
A preventative medicine task force is trying to identify and combat peripheral arterial disease
among the rural population they serve. They seek information regarding a rapid, low cost, and
sensitive tool to detect this disease that can be used at health fairs scheduled to take place in
the rural town centers. Which of the following would be the best screening tool for this
situation?
A. Doppler ultrasound
B. 5-minute treadmill test
C. Ankle-brachial pressure index (ABI)
D. Pedal pulse palpation - ANSWER>>D. Pedal pulse palpation. In a study of over 18,000 men,
the presence of bilateral dorsalis pedis and posterior tibial pulses ruled out peripheral arterial
disease (PAD) with enough reliability for the authors to conclude it could be used as an
appropriate initial screening tool for PAD. In order for pedal pulse palpation (PPP) to effectively
screen for PAD, if any of the 4 pedal pulses are absent, the patient should be referred to a
primary care provider to receive ABI testing for PAD, which is a more specific tool. ABI testing,
which involves calculating a pressure ratio between the ankle and arm blood pressure, involves
specific training and equipment. Although it is often used as an initial test for PAD in the office
setting with one clinician and patient, at a health fair where rapid low cost, low equipment
screening is needed, there is a better option. PAD is common at the population level, with
estimates of around 10% prevalence in adults over 55.
4
