WGU D118 Practice OA Exam QUESTIONS WITH
WELL VERIFIED ANSWERS
A 63-year-old man presents with progressive exertional dyspnea, orthopnea, and bilateral lower
extremity edema. Exam reveals bibasilar crackles and S3 gallop. Echo shows EF 32%. Which
regimen is most appropriate to begin long-term mortality-reducing treatment? A. Furosemide
only B. ACE inhibitor plus evidence-based beta blocker C. Digoxin plus spironolactone only D.
Diltiazem plus hydrochlorothiazide - answer☑️✔️..B. ACE inhibitor plus evidence-based beta
blocker — HFrEF mortality reduction starts with guideline-directed therapy such as an ACE
inhibitor plus evidence-based beta blocker.
A 54-year-old woman with fatigue has the following labs: Hgb 9.8 g/dL, MCV 69, ferritin low,
TIBC high. What is the most likely diagnosis? A. Anemia of chronic disease B. Iron deficiency
anemia C. Thalassemia D. Vitamin B12 deficiency - answer☑️✔️..B. Iron deficiency anemia —
microcytic anemia with low ferritin and high TIBC is classic.
A 28-year-old woman presents with dysuria, urinary frequency, and urgency for 2 days. No fever,
flank pain, vaginal discharge, or pregnancy. UA is positive for nitrites and leukocyte esterase.
Best first-line treatment? A. Nitrofurantoin B. Ciprofloxacin C. Amoxicillin-clavulanate D.
Metronidazole - answer☑️✔️..A. Nitrofurantoin — first-line for uncomplicated cystitis.
A 72-year-old smoker presents with painless gross hematuria. No dysuria or fever. What is the
next best step? A. Treat empirically for UTI B. Repeat urinalysis in 1 month C. CT urogram and
urology referral D. PSA level - answer☑️✔️..C. CT urogram and urology referral — painless
hematuria in a smoker is urinary tract malignancy until proven otherwise.
A 37-year-old woman presents with fatigue, salt craving, weight loss, hyperpigmentation,
hypotension, hyponatremia, and hyperkalemia. Which diagnosis is most likely? A. Cushing
syndrome B. Primary adrenal insufficiency C. Hyperthyroidism D. SIADH - answer☑️✔️..B.
Primary adrenal insufficiency — classic Addison disease presentation.
,A patient with suspected primary adrenal insufficiency needs confirmatory testing. Which test is
most appropriate? A. TSH and free T4 B. ACTH stimulation test C. Overnight dexamethasone
suppression test D. Plasma renin alone - answer☑️✔️..B. ACTH stimulation test — confirms
adrenal insufficiency.
A 67-year-old patient has chronic cough, exertional dyspnea, fatigue, bibasilar crackles, and
chest X-ray showing bilateral interstitial markings without focal infiltrate. What is the next best
diagnostic test? A. Repeat chest X-ray in 4 weeks B. High-resolution CT chest C. Sputum culture
D. Bronchodilator challenge first - answer☑️✔️..B. High-resolution CT chest — best next test
for suspected interstitial lung disease.
A patient presents with fever, productive cough, pleuritic chest pain, and focal crackles. Which
finding most strongly supports community-acquired pneumonia over acute bronchitis? A.
Rhinorrhea B. Focal crackles with fever C. Cough lasting 5 days D. Mild wheeze alone -
answer☑️✔️..B. Focal crackles with fever — more consistent with pneumonia.
A 24-year-old presents with fever, severe sore throat, muffled voice, drooling, and uvular
deviation. Best next step? A. Oral penicillin and discharge B. Incision and drainage in clinic C.
Emergency evaluation for peritonsillar abscess D. Treat as viral pharyngitis - answer☑️✔️..C.
Emergency evaluation for peritonsillar abscess — airway risk and deep space infection concern.
A 59-year-old man has central obesity, BP 146/92, fasting glucose 112, triglycerides 230, HDL 34.
Most likely diagnosis? A. Type 1 diabetes B. Metabolic syndrome C. Cushing disease D. Familial
hypercholesterolemia - answer☑️✔️..B. Metabolic syndrome — central obesity, HTN, low HDL,
high TG, impaired fasting glucose.
A 48-year-old woman presents with acute painful swelling and erythema of the first MTP joint
after a weekend of alcohol intake. Best acute therapy? A. Start allopurinol today as sole therapy
B. NSAID or colchicine C. Methotrexate D. Probenecid - answer☑️✔️..B. NSAID or colchicine —
first-line for an acute gout flare.
, A patient has recurrent gout flares and visible tophi. Which medication is appropriate for long-
term urate lowering after acute symptoms improve? A. Colchicine only B. Ibuprofen daily C.
Allopurinol D. Prednisone taper monthly - answer☑️✔️..C. Allopurinol — indicated for chronic
urate lowering in recurrent gout/tophi.
A 45-year-old woman reports symmetric MCP and PIP pain, prolonged morning stiffness, and
fatigue. What diagnosis is most likely? A. Osteoarthritis B. Rheumatoid arthritis C. Gout D.
Fibromyalgia - answer☑️✔️..B. Rheumatoid arthritis — inflammatory small-joint symmetric
pattern.
A patient with rheumatoid arthritis has persistent symptoms despite NSAIDs. Which is the best
first-line disease-modifying medication? A. Colchicine B. Methotrexate C. Allopurinol D.
Acetaminophen - answer☑️✔️..B. Methotrexate — first-line DMARD for RA.
A 70-year-old reports proximal shoulder and hip girdle aching with morning stiffness. ESR is
elevated. No focal weakness. Most likely diagnosis? A. Fibromyalgia B. Polymyalgia rheumatica
C. Myasthenia gravis D. Osteoarthritis - answer☑️✔️..B. Polymyalgia rheumatica — proximal
stiffness with elevated ESR in older adult.
A patient with suspected polymyalgia rheumatica also reports new headache, scalp tenderness,
and jaw claudication. Best next step? A. Reassure and repeat ESR later B. Start high-dose
steroids urgently C. Order physical therapy only D. Start methotrexate only - answer☑️✔️..B.
Start high-dose steroids urgently — concern for giant cell arteritis and vision loss.
A 31-year-old woman has malar rash, joint pain, photosensitivity, oral ulcers, and proteinuria.
Most likely diagnosis? A. Dermatomyositis B. Systemic lupus erythematosus C. Psoriatic arthritis
D. Rosacea - answer☑️✔️..B. Systemic lupus erythematosus — classic multisystem
autoimmune picture.
A pregnant patient with lupus has a history of recurrent spontaneous abortions. Which therapy
is commonly used to help prevent future pregnancy loss when antiphospholipid syndrome is
suspected? A. Methotrexate B. Aspirin plus heparin C. Isotretinoin D. Warfarin in first trimester -
WELL VERIFIED ANSWERS
A 63-year-old man presents with progressive exertional dyspnea, orthopnea, and bilateral lower
extremity edema. Exam reveals bibasilar crackles and S3 gallop. Echo shows EF 32%. Which
regimen is most appropriate to begin long-term mortality-reducing treatment? A. Furosemide
only B. ACE inhibitor plus evidence-based beta blocker C. Digoxin plus spironolactone only D.
Diltiazem plus hydrochlorothiazide - answer☑️✔️..B. ACE inhibitor plus evidence-based beta
blocker — HFrEF mortality reduction starts with guideline-directed therapy such as an ACE
inhibitor plus evidence-based beta blocker.
A 54-year-old woman with fatigue has the following labs: Hgb 9.8 g/dL, MCV 69, ferritin low,
TIBC high. What is the most likely diagnosis? A. Anemia of chronic disease B. Iron deficiency
anemia C. Thalassemia D. Vitamin B12 deficiency - answer☑️✔️..B. Iron deficiency anemia —
microcytic anemia with low ferritin and high TIBC is classic.
A 28-year-old woman presents with dysuria, urinary frequency, and urgency for 2 days. No fever,
flank pain, vaginal discharge, or pregnancy. UA is positive for nitrites and leukocyte esterase.
Best first-line treatment? A. Nitrofurantoin B. Ciprofloxacin C. Amoxicillin-clavulanate D.
Metronidazole - answer☑️✔️..A. Nitrofurantoin — first-line for uncomplicated cystitis.
A 72-year-old smoker presents with painless gross hematuria. No dysuria or fever. What is the
next best step? A. Treat empirically for UTI B. Repeat urinalysis in 1 month C. CT urogram and
urology referral D. PSA level - answer☑️✔️..C. CT urogram and urology referral — painless
hematuria in a smoker is urinary tract malignancy until proven otherwise.
A 37-year-old woman presents with fatigue, salt craving, weight loss, hyperpigmentation,
hypotension, hyponatremia, and hyperkalemia. Which diagnosis is most likely? A. Cushing
syndrome B. Primary adrenal insufficiency C. Hyperthyroidism D. SIADH - answer☑️✔️..B.
Primary adrenal insufficiency — classic Addison disease presentation.
,A patient with suspected primary adrenal insufficiency needs confirmatory testing. Which test is
most appropriate? A. TSH and free T4 B. ACTH stimulation test C. Overnight dexamethasone
suppression test D. Plasma renin alone - answer☑️✔️..B. ACTH stimulation test — confirms
adrenal insufficiency.
A 67-year-old patient has chronic cough, exertional dyspnea, fatigue, bibasilar crackles, and
chest X-ray showing bilateral interstitial markings without focal infiltrate. What is the next best
diagnostic test? A. Repeat chest X-ray in 4 weeks B. High-resolution CT chest C. Sputum culture
D. Bronchodilator challenge first - answer☑️✔️..B. High-resolution CT chest — best next test
for suspected interstitial lung disease.
A patient presents with fever, productive cough, pleuritic chest pain, and focal crackles. Which
finding most strongly supports community-acquired pneumonia over acute bronchitis? A.
Rhinorrhea B. Focal crackles with fever C. Cough lasting 5 days D. Mild wheeze alone -
answer☑️✔️..B. Focal crackles with fever — more consistent with pneumonia.
A 24-year-old presents with fever, severe sore throat, muffled voice, drooling, and uvular
deviation. Best next step? A. Oral penicillin and discharge B. Incision and drainage in clinic C.
Emergency evaluation for peritonsillar abscess D. Treat as viral pharyngitis - answer☑️✔️..C.
Emergency evaluation for peritonsillar abscess — airway risk and deep space infection concern.
A 59-year-old man has central obesity, BP 146/92, fasting glucose 112, triglycerides 230, HDL 34.
Most likely diagnosis? A. Type 1 diabetes B. Metabolic syndrome C. Cushing disease D. Familial
hypercholesterolemia - answer☑️✔️..B. Metabolic syndrome — central obesity, HTN, low HDL,
high TG, impaired fasting glucose.
A 48-year-old woman presents with acute painful swelling and erythema of the first MTP joint
after a weekend of alcohol intake. Best acute therapy? A. Start allopurinol today as sole therapy
B. NSAID or colchicine C. Methotrexate D. Probenecid - answer☑️✔️..B. NSAID or colchicine —
first-line for an acute gout flare.
, A patient has recurrent gout flares and visible tophi. Which medication is appropriate for long-
term urate lowering after acute symptoms improve? A. Colchicine only B. Ibuprofen daily C.
Allopurinol D. Prednisone taper monthly - answer☑️✔️..C. Allopurinol — indicated for chronic
urate lowering in recurrent gout/tophi.
A 45-year-old woman reports symmetric MCP and PIP pain, prolonged morning stiffness, and
fatigue. What diagnosis is most likely? A. Osteoarthritis B. Rheumatoid arthritis C. Gout D.
Fibromyalgia - answer☑️✔️..B. Rheumatoid arthritis — inflammatory small-joint symmetric
pattern.
A patient with rheumatoid arthritis has persistent symptoms despite NSAIDs. Which is the best
first-line disease-modifying medication? A. Colchicine B. Methotrexate C. Allopurinol D.
Acetaminophen - answer☑️✔️..B. Methotrexate — first-line DMARD for RA.
A 70-year-old reports proximal shoulder and hip girdle aching with morning stiffness. ESR is
elevated. No focal weakness. Most likely diagnosis? A. Fibromyalgia B. Polymyalgia rheumatica
C. Myasthenia gravis D. Osteoarthritis - answer☑️✔️..B. Polymyalgia rheumatica — proximal
stiffness with elevated ESR in older adult.
A patient with suspected polymyalgia rheumatica also reports new headache, scalp tenderness,
and jaw claudication. Best next step? A. Reassure and repeat ESR later B. Start high-dose
steroids urgently C. Order physical therapy only D. Start methotrexate only - answer☑️✔️..B.
Start high-dose steroids urgently — concern for giant cell arteritis and vision loss.
A 31-year-old woman has malar rash, joint pain, photosensitivity, oral ulcers, and proteinuria.
Most likely diagnosis? A. Dermatomyositis B. Systemic lupus erythematosus C. Psoriatic arthritis
D. Rosacea - answer☑️✔️..B. Systemic lupus erythematosus — classic multisystem
autoimmune picture.
A pregnant patient with lupus has a history of recurrent spontaneous abortions. Which therapy
is commonly used to help prevent future pregnancy loss when antiphospholipid syndrome is
suspected? A. Methotrexate B. Aspirin plus heparin C. Isotretinoin D. Warfarin in first trimester -
