WGU D118 OA Study Guide Real Practice
Questions (2026/2027) | Verified Answers |
A+
• 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 -✓✓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 -✓✓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 -✓✓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 -✓✓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 -✓✓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 -✓✓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 -✓✓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 -✓✓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 -✓✓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 -✓✓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 -✓✓B. Aspirin plus heparin — standard prevention strategy in
lupus with suspected APS pregnancy loss.
• A 64-year-old smoker has persistent cough, weight loss, and hemoptysis. Next best
test? A. Spirometry B. Chest CT C. Repeat chest X-ray in 3 months D. Trial of
azithromycin -✓✓B. Chest CT — concerning for lung malignancy.
• A 58-year-old with smoking history presents for preventive screening. Which screening
is specifically recommended for a man age 65-75 who has ever smoked? A. Annual
chest X-ray B. Abdominal ultrasound for AAA C. PSA every year D. Echocardiogram -
✓✓B. Abdominal ultrasound for AAA — recommended one-time screening in men 65-75
who ever smoked.
• A 66-year-old man with irregularly irregular rhythm is found to have atrial fibrillation. He
is hemodynamically stable. What is the immediate outpatient management priority
besides rate control? A. Start aspirin for all patients B. Assess stroke risk for
anticoagulation decision C. Send home with no treatment D. Immediate cardioversion in
clinic for all patients -✓✓B. Assess stroke risk for anticoagulation decision — use
CHA2DS2-VASc.
• A patient with atrial fibrillation has a CHA2DS2-VASc score of 4. Best management?
A. No antithrombotic therapy B. Aspirin only C. Oral anticoagulation D. Clopidogrel only
-✓✓C. Oral anticoagulation — elevated stroke risk.
• A patient reports palpitations. ECG shows narrow-complex tachycardia at 180 bpm,
regular rhythm, no visible P waves. Stable vitals. Best initial treatment? A. Adenosine
after vagal maneuvers B. Amiodarone infusion C. Immediate defibrillation D. Digoxin -
✓✓A. Adenosine after vagal maneuvers — stable SVT treatment.
Questions (2026/2027) | Verified Answers |
A+
• 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 -✓✓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 -✓✓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 -✓✓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 -✓✓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 -✓✓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 -✓✓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 -✓✓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 -✓✓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 -✓✓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 -✓✓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 -✓✓B. Aspirin plus heparin — standard prevention strategy in
lupus with suspected APS pregnancy loss.
• A 64-year-old smoker has persistent cough, weight loss, and hemoptysis. Next best
test? A. Spirometry B. Chest CT C. Repeat chest X-ray in 3 months D. Trial of
azithromycin -✓✓B. Chest CT — concerning for lung malignancy.
• A 58-year-old with smoking history presents for preventive screening. Which screening
is specifically recommended for a man age 65-75 who has ever smoked? A. Annual
chest X-ray B. Abdominal ultrasound for AAA C. PSA every year D. Echocardiogram -
✓✓B. Abdominal ultrasound for AAA — recommended one-time screening in men 65-75
who ever smoked.
• A 66-year-old man with irregularly irregular rhythm is found to have atrial fibrillation. He
is hemodynamically stable. What is the immediate outpatient management priority
besides rate control? A. Start aspirin for all patients B. Assess stroke risk for
anticoagulation decision C. Send home with no treatment D. Immediate cardioversion in
clinic for all patients -✓✓B. Assess stroke risk for anticoagulation decision — use
CHA2DS2-VASc.
• A patient with atrial fibrillation has a CHA2DS2-VASc score of 4. Best management?
A. No antithrombotic therapy B. Aspirin only C. Oral anticoagulation D. Clopidogrel only
-✓✓C. Oral anticoagulation — elevated stroke risk.
• A patient reports palpitations. ECG shows narrow-complex tachycardia at 180 bpm,
regular rhythm, no visible P waves. Stable vitals. Best initial treatment? A. Adenosine
after vagal maneuvers B. Amiodarone infusion C. Immediate defibrillation D. Digoxin -
✓✓A. Adenosine after vagal maneuvers — stable SVT treatment.
