WGU D118 ACTUAL EXAM 5 QUESTIONS WITH
VERIFIED SOLUTIONS
A heavy smoker is in the ER complaining of generalized fatigue. He claims that he is
always out of breath and has no more energy. His only medications are bronchodilators,
which he rarely uses. Auscultation reveals enhanced resonance of voice sounds in his left
chest. What is the most likely cause of this physical finding?
A. Asthma
B. Pneumonia
C. Emphysema
D. Pneumothorax
B. Pneumonia. Egophony is an increased resonance of voice sounds when a medical professional
auscultates the lungs. It is most pronounced in patients with pneumonia and fibrosis. There is
enhanced transmission of high frequency noise across fluid. Similarly, bronchophony and
whispered pectoriloquy can be used to assess the lungs.
A 35-year old primigravida comes to an antenatal clinic for her first obstetric visit. Her
LMP was five weeks ago. She has a known case of HIV diagnosed 6 years ago and is
adherent to her triple drug ART regimen with an undetectable viral load. At 35 weeks her
viral load is still undetectable and she gives birth via normal vaginal delivery at 39 weeks.
At discharge ART regimens for the mother and child are finalized. Which of the following
recommendations about breastfeeding in HIV positive mothers is most accurate?
A. There is no significant risk of HIV transmission via breastfeeding in mothers under 30
years of age.
B. In resource rich settings the benefits of breastfeeding outweigh the risk of HIV
transmission
C. Maternal antibodies in breastmilk will protect the infant from HIV infection
D. The risk of HIV transmission from breastmilk makes breastfeeding unadvisable
D. The risk of HIV Transmission from breastmilk makes breastfeeding unadvisable. Rationale:
10%-14% of breastfeeding mothers transmit HIV to the uninfected infant. The US official
guidelines by the panel on treatment of pregnant women with HIV infection and prevention of
perinatal infection state that HIV positive women must avoid breastfeeding as transmission of
HIV through breastmilk is still possible despite ART therapy. In parts of the world that lack
adequate resources the benefit of breastfeeding may outweigh these risks.
A 43 year old IV drug user who has been on ART treatment complains of continuous
diarrhea that is watery, epigastric pain and difficulty swallowing. His CBC shows a
hemoglobin of 7.0 mg/dl, total leukocyte count of 2900cmm and a platelet count of 70,000.
A CD4+ cell count was requested and it came out to be 90/cmm. Which of the following
laboratory investigations would best help with the further evaluation of his diarrhea?
,A. Stool tests for oocysts of cryptosporidium
B. Blood cultures for progressive disseminated histoplasmosis
C. Microscopy for pseudohyphae of Candida albicans
D. A stool for ova and parasites test for giardiasis
A. Stool tests for oocysts of cryptosporidium. Rationale: The scenario is indicative of diarrhea
due to cryptosporidium which is a protozoan and responsible for causing severe diarrhea in
AIDS. This is seen when CD4+ cell counts lower than 100 per cubic mm. The diarrhea is of
chronic nature and watery. The diagnosis is based on finding acid fast oocysts in stool and also
by antigen detection. With declining CD4+ counts opportunistic infections become common.
Histoplasmosis usually presents with CD4+ counts usually between 100-200 cubic mm and
fever, cough, dyspnea are the predominant symptoms. Giardiasis has no specific association with
AIDs and presents usually with fatty diarrhea, not watery. Candida Albicans causes esophagitis
at cell counts lower than 100 per cubic mm which explains the features of epigastric pain and
dysphagia but has no associations with diarrhea.
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
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
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. 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
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?
A. Prescribe tacrolimus
B. Increase the dose of cyclosporine
C. Prescribe amoxicillin
D. Prescribe paracetamol
, 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
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?
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
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.
VERIFIED SOLUTIONS
A heavy smoker is in the ER complaining of generalized fatigue. He claims that he is
always out of breath and has no more energy. His only medications are bronchodilators,
which he rarely uses. Auscultation reveals enhanced resonance of voice sounds in his left
chest. What is the most likely cause of this physical finding?
A. Asthma
B. Pneumonia
C. Emphysema
D. Pneumothorax
B. Pneumonia. Egophony is an increased resonance of voice sounds when a medical professional
auscultates the lungs. It is most pronounced in patients with pneumonia and fibrosis. There is
enhanced transmission of high frequency noise across fluid. Similarly, bronchophony and
whispered pectoriloquy can be used to assess the lungs.
A 35-year old primigravida comes to an antenatal clinic for her first obstetric visit. Her
LMP was five weeks ago. She has a known case of HIV diagnosed 6 years ago and is
adherent to her triple drug ART regimen with an undetectable viral load. At 35 weeks her
viral load is still undetectable and she gives birth via normal vaginal delivery at 39 weeks.
At discharge ART regimens for the mother and child are finalized. Which of the following
recommendations about breastfeeding in HIV positive mothers is most accurate?
A. There is no significant risk of HIV transmission via breastfeeding in mothers under 30
years of age.
B. In resource rich settings the benefits of breastfeeding outweigh the risk of HIV
transmission
C. Maternal antibodies in breastmilk will protect the infant from HIV infection
D. The risk of HIV transmission from breastmilk makes breastfeeding unadvisable
D. The risk of HIV Transmission from breastmilk makes breastfeeding unadvisable. Rationale:
10%-14% of breastfeeding mothers transmit HIV to the uninfected infant. The US official
guidelines by the panel on treatment of pregnant women with HIV infection and prevention of
perinatal infection state that HIV positive women must avoid breastfeeding as transmission of
HIV through breastmilk is still possible despite ART therapy. In parts of the world that lack
adequate resources the benefit of breastfeeding may outweigh these risks.
A 43 year old IV drug user who has been on ART treatment complains of continuous
diarrhea that is watery, epigastric pain and difficulty swallowing. His CBC shows a
hemoglobin of 7.0 mg/dl, total leukocyte count of 2900cmm and a platelet count of 70,000.
A CD4+ cell count was requested and it came out to be 90/cmm. Which of the following
laboratory investigations would best help with the further evaluation of his diarrhea?
,A. Stool tests for oocysts of cryptosporidium
B. Blood cultures for progressive disseminated histoplasmosis
C. Microscopy for pseudohyphae of Candida albicans
D. A stool for ova and parasites test for giardiasis
A. Stool tests for oocysts of cryptosporidium. Rationale: The scenario is indicative of diarrhea
due to cryptosporidium which is a protozoan and responsible for causing severe diarrhea in
AIDS. This is seen when CD4+ cell counts lower than 100 per cubic mm. The diarrhea is of
chronic nature and watery. The diagnosis is based on finding acid fast oocysts in stool and also
by antigen detection. With declining CD4+ counts opportunistic infections become common.
Histoplasmosis usually presents with CD4+ counts usually between 100-200 cubic mm and
fever, cough, dyspnea are the predominant symptoms. Giardiasis has no specific association with
AIDs and presents usually with fatty diarrhea, not watery. Candida Albicans causes esophagitis
at cell counts lower than 100 per cubic mm which explains the features of epigastric pain and
dysphagia but has no associations with diarrhea.
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
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
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. 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
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?
A. Prescribe tacrolimus
B. Increase the dose of cyclosporine
C. Prescribe amoxicillin
D. Prescribe paracetamol
, 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
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?
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
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.
