WGU D118 ADULT PRIMARY CARE FINAL
PAPER UPDATED COMPLETE QUESTIONS
AND CORRECT ANSWERS BUNDLED
REVIEW GUIDE
●● 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
PAPER UPDATED COMPLETE QUESTIONS
AND CORRECT ANSWERS BUNDLED
REVIEW GUIDE
●● 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
