NR 667 / NR667 VISE STUDY GUIDE EXAM COMPLETE QUESTIONS
WITH ANSWERS 100% VERIFIED 2025 LATEST UPDATED ALREADY
GRADED A+
Question 1
A 55-year-old African American male presents for a follow-up on hypertension. His blood
pressure today is 152/94 mmHg. He is currently on no medications. According to JNC 8
and ACC/AHA guidelines, which of the following is the most appropriate initial
pharmacological therapy for this patient?
A) Lisinopril (ACE Inhibitor)
B) Losartan (ARB)
C) Amlodipine (Calcium Channel Blocker)
D) Metoprolol (Beta Blocker)
E) Spironolactone (Aldosterone Antagonist)
Correct Answer: C) Amlodipine (Calcium Channel Blocker)
Rationale: Guidelines (JNC 8) recommend that for the general African American
population (without Chronic Kidney Disease), initial antihypertensive therapy should
include a Thiazide-type diuretic or a Calcium Channel Blocker (CCB). ACE inhibitors and
ARBs are less effective as monotherapy in this population due to low-renin profiles,
although they are preferred if CKD is present.
Question 2
A 24-year-old female presents with a complaint of a thin, gray-white vaginal discharge with
a "fishy" odor, especially after intercourse. A wet mount is performed. Which finding
would confirm the diagnosis of Bacterial Vaginosis (BV)?
A) Hyphae and spores (pseudohyphae).
B) Clue cells (epithelial cells with borders obscured by bacteria).
C) Motile trichomonads.
D) numerous White Blood Cells (WBCs) > 10 per HPF.
E) Low vaginal pH (< 3.5).
Correct Answer: B) Clue cells (epithelial cells with borders obscured by bacteria).
Rationale: The Amsel Criteria for diagnosing Bacterial Vaginosis requires 3 of 4 signs: 1)
Homogeneous, thin, grayish-white discharge; 2) Vaginal pH > 4.5; 3) Positive Whiff test
(amine odor with KOH); 4) Presence of Clue Cells on wet mount. Hyphae indicate Candida
(Yeast); Trichomonads indicate Trichomoniasis.
Question 3
A 45-year-old female presents with fatigue, weight gain, and cold intolerance. Her TSH is
12.5 mIU/L (High) and her Free T4 is 0.6 ng/dL (Low). You diagnose her with Primary
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Hypothyroidism. What is the recommended starting dose of Levothyroxine for a healthy
adult?
A) 25 mcg daily
B) 1.6 mcg/kg/day based on ideal body weight
C) 50 mcg twice daily
D) 200 mcg daily
E) 0.5 mcg/kg/day
Correct Answer: B) 1.6 mcg/kg/day based on ideal body weight
Rationale: The full replacement dose for Levothyroxine in a healthy adult is approximately
1.6 mcg/kg/day. In elderly patients or those with coronary artery disease, one would start
"low and slow" (e.g., 25-50 mcg) to avoid straining the heart, but a healthy 45-year-old can
start at the calculated replacement dose.
Question 4
You are assessing a 6-month-old infant. Which of the following physical exam findings is
considered a "Red Flag" requiring immediate referral or investigation?
A) Anterior fontanelle is open and flat.
B) Presence of a primitive Moro reflex.
C) Absence of a social smile.
D) Ability to roll from front to back.
E) Eruption of the first tooth (central incisor).
Correct Answer: C) Absence of a social smile.
Rationale: A social smile should develop by 2 months of age. Absence of a social smile at 6
months is a significant developmental red flag suggesting neurological or visual impairment
or autism spectrum disorder. The Moro reflex usually disappears by 3-4 months, so
its presence at 6 months is concerning, but the absence of a smile is a profound
social/cognitive delay.
Question 5
A patient with Type 2 Diabetes is currently taking Metformin 1000 mg BID. His A1C is
8.5%. You decide to add a second agent. He has a history of heart failure and you want a
drug that has proven cardiovascular benefit. Which class would be the best choice?
A) Sulfonylurea (e.g., Glipizide)
B) SGLT-2 Inhibitor (e.g., Empagliflozin/Jardiance)
C) DPP-4 Inhibitor (e.g., Sitagliptin/Januvia)
D) Thiazolidinedione (e.g., Pioglitazone)
E) Insulin Glargine
,[Type here]
Correct Answer: B) SGLT-2 Inhibitor (e.g., Empagliflozin/Jardiance)
Rationale: SGLT-2 Inhibitors (ending in -flozin) and GLP-1 Agonists are preferred add-on
therapies for patients with established Atherosclerotic Cardiovascular Disease (ASCVD) or
Heart Failure. SGLT-2s specifically reduce hospitalization for heart failure.
Thiazolidinediones (TZDs) can cause fluid retention and are generally contraindicated in
heart failure.
Question 6
A 65-year-old male smoker presents with a painless, ulcerated lesion on his lower lip that
has been slowly growing for 3 months. It is indurated and bleeds occasionally. What is the
most likely diagnosis?
A) Herpes Simplex Virus type 1
B) Squamous Cell Carcinoma (SCC)
C) Basal Cell Carcinoma (BCC)
D) Aphthous Ulcer
E) Actinic Keratosis
Correct Answer: B) Squamous Cell Carcinoma (SCC)
Rationale: Squamous Cell Carcinoma is the most common oral cancer. Risk factors include
smoking and alcohol use. It typically presents as a non-healing, painless, indurated ulcer or
nodule, often on the lower lip (sun exposure + pipe/cigarette placement). BCC is more
common on the upper face/nose and often looks pearly.
Question 7
A 3-year-old child is diagnosed with Acute Otitis Media (AOM). He has no known drug
allergies and has not taken antibiotics in the last 6 months. What is the first-line antibiotic
choice?
A) Amoxicillin 80-90 mg/kg/day
B) Azithromycin 10 mg/kg/day
C) Cefdinir 14 mg/kg/day
D) Amoxicillin-Clavulanate (Augmentin) 90 mg/kg/day
E) Ceftriaxone IM injection
Correct Answer: A) Amoxicillin 80-90 mg/kg/day
Rationale: High-dose Amoxicillin is the first-line treatment for uncomplicated AOM to
overcome resistant Streptococcus pneumoniae. Augmentin is reserved for treatment failure
(if symptoms persist after 48-72 hours of Amoxicillin) or if the child had antibiotics
recently.
, [Type here]
Question 8
You are evaluating a patient with a "Drop Arm" test. The patient is unable to slowly lower
their arm from 90 degrees of abduction; it drops suddenly. This finding is highly specific
for:
A) Bicipital Tendonitis
B) Rotator Cuff Tear (specifically Supraspinatus)
C) Adhesive Capsulitis (Frozen Shoulder)
D) Acromioclavicular (AC) Separation
E) Glenohumeral Dislocation
Correct Answer: B) Rotator Cuff Tear (specifically Supraspinatus)
Rationale: The Drop Arm test assesses the integrity of the rotator cuff, specifically the
supraspinatus tendon. Inability to control the lowering of the arm indicates a full-thickness
tear.
Question 9
A 22-year-old female presents with lower abdominal pain, fever, and vaginal discharge. On
physical exam, she has marked Cervical Motion Tenderness (Chandelier Sign). What is the
most likely diagnosis?
A) Ectopic Pregnancy
B) Appendicitis
C) Pelvic Inflammatory Disease (PID)
D) Ovarian Cyst Rupture
E) Urinary Tract Infection
Correct Answer: C) Pelvic Inflammatory Disease (PID)
Rationale: The classic triad for PID is pelvic pain, adnexal tenderness, and cervical motion
tenderness (CMT). The "Chandelier Sign" refers to the patient reaching up in pain (as if to
grab a chandelier) during the bimanual exam due to the severity of the CMT.
Question 10
According to the GOLD guidelines for COPD, which class of medication is the foundation
of therapy for patients with Group B or higher (symptomatic) COPD?
A) Short-Acting Beta Agonists (SABA) only
B) Inhaled Corticosteroids (ICS) monotherapy
C) Long-Acting Muscarinic Antagonists (LAMA) or Long-Acting Beta Agonists (LABA)
D) Systemic Steroids (Prednisone)
E) Antibiotics (Azithromycin)
WITH ANSWERS 100% VERIFIED 2025 LATEST UPDATED ALREADY
GRADED A+
Question 1
A 55-year-old African American male presents for a follow-up on hypertension. His blood
pressure today is 152/94 mmHg. He is currently on no medications. According to JNC 8
and ACC/AHA guidelines, which of the following is the most appropriate initial
pharmacological therapy for this patient?
A) Lisinopril (ACE Inhibitor)
B) Losartan (ARB)
C) Amlodipine (Calcium Channel Blocker)
D) Metoprolol (Beta Blocker)
E) Spironolactone (Aldosterone Antagonist)
Correct Answer: C) Amlodipine (Calcium Channel Blocker)
Rationale: Guidelines (JNC 8) recommend that for the general African American
population (without Chronic Kidney Disease), initial antihypertensive therapy should
include a Thiazide-type diuretic or a Calcium Channel Blocker (CCB). ACE inhibitors and
ARBs are less effective as monotherapy in this population due to low-renin profiles,
although they are preferred if CKD is present.
Question 2
A 24-year-old female presents with a complaint of a thin, gray-white vaginal discharge with
a "fishy" odor, especially after intercourse. A wet mount is performed. Which finding
would confirm the diagnosis of Bacterial Vaginosis (BV)?
A) Hyphae and spores (pseudohyphae).
B) Clue cells (epithelial cells with borders obscured by bacteria).
C) Motile trichomonads.
D) numerous White Blood Cells (WBCs) > 10 per HPF.
E) Low vaginal pH (< 3.5).
Correct Answer: B) Clue cells (epithelial cells with borders obscured by bacteria).
Rationale: The Amsel Criteria for diagnosing Bacterial Vaginosis requires 3 of 4 signs: 1)
Homogeneous, thin, grayish-white discharge; 2) Vaginal pH > 4.5; 3) Positive Whiff test
(amine odor with KOH); 4) Presence of Clue Cells on wet mount. Hyphae indicate Candida
(Yeast); Trichomonads indicate Trichomoniasis.
Question 3
A 45-year-old female presents with fatigue, weight gain, and cold intolerance. Her TSH is
12.5 mIU/L (High) and her Free T4 is 0.6 ng/dL (Low). You diagnose her with Primary
,[Type here]
Hypothyroidism. What is the recommended starting dose of Levothyroxine for a healthy
adult?
A) 25 mcg daily
B) 1.6 mcg/kg/day based on ideal body weight
C) 50 mcg twice daily
D) 200 mcg daily
E) 0.5 mcg/kg/day
Correct Answer: B) 1.6 mcg/kg/day based on ideal body weight
Rationale: The full replacement dose for Levothyroxine in a healthy adult is approximately
1.6 mcg/kg/day. In elderly patients or those with coronary artery disease, one would start
"low and slow" (e.g., 25-50 mcg) to avoid straining the heart, but a healthy 45-year-old can
start at the calculated replacement dose.
Question 4
You are assessing a 6-month-old infant. Which of the following physical exam findings is
considered a "Red Flag" requiring immediate referral or investigation?
A) Anterior fontanelle is open and flat.
B) Presence of a primitive Moro reflex.
C) Absence of a social smile.
D) Ability to roll from front to back.
E) Eruption of the first tooth (central incisor).
Correct Answer: C) Absence of a social smile.
Rationale: A social smile should develop by 2 months of age. Absence of a social smile at 6
months is a significant developmental red flag suggesting neurological or visual impairment
or autism spectrum disorder. The Moro reflex usually disappears by 3-4 months, so
its presence at 6 months is concerning, but the absence of a smile is a profound
social/cognitive delay.
Question 5
A patient with Type 2 Diabetes is currently taking Metformin 1000 mg BID. His A1C is
8.5%. You decide to add a second agent. He has a history of heart failure and you want a
drug that has proven cardiovascular benefit. Which class would be the best choice?
A) Sulfonylurea (e.g., Glipizide)
B) SGLT-2 Inhibitor (e.g., Empagliflozin/Jardiance)
C) DPP-4 Inhibitor (e.g., Sitagliptin/Januvia)
D) Thiazolidinedione (e.g., Pioglitazone)
E) Insulin Glargine
,[Type here]
Correct Answer: B) SGLT-2 Inhibitor (e.g., Empagliflozin/Jardiance)
Rationale: SGLT-2 Inhibitors (ending in -flozin) and GLP-1 Agonists are preferred add-on
therapies for patients with established Atherosclerotic Cardiovascular Disease (ASCVD) or
Heart Failure. SGLT-2s specifically reduce hospitalization for heart failure.
Thiazolidinediones (TZDs) can cause fluid retention and are generally contraindicated in
heart failure.
Question 6
A 65-year-old male smoker presents with a painless, ulcerated lesion on his lower lip that
has been slowly growing for 3 months. It is indurated and bleeds occasionally. What is the
most likely diagnosis?
A) Herpes Simplex Virus type 1
B) Squamous Cell Carcinoma (SCC)
C) Basal Cell Carcinoma (BCC)
D) Aphthous Ulcer
E) Actinic Keratosis
Correct Answer: B) Squamous Cell Carcinoma (SCC)
Rationale: Squamous Cell Carcinoma is the most common oral cancer. Risk factors include
smoking and alcohol use. It typically presents as a non-healing, painless, indurated ulcer or
nodule, often on the lower lip (sun exposure + pipe/cigarette placement). BCC is more
common on the upper face/nose and often looks pearly.
Question 7
A 3-year-old child is diagnosed with Acute Otitis Media (AOM). He has no known drug
allergies and has not taken antibiotics in the last 6 months. What is the first-line antibiotic
choice?
A) Amoxicillin 80-90 mg/kg/day
B) Azithromycin 10 mg/kg/day
C) Cefdinir 14 mg/kg/day
D) Amoxicillin-Clavulanate (Augmentin) 90 mg/kg/day
E) Ceftriaxone IM injection
Correct Answer: A) Amoxicillin 80-90 mg/kg/day
Rationale: High-dose Amoxicillin is the first-line treatment for uncomplicated AOM to
overcome resistant Streptococcus pneumoniae. Augmentin is reserved for treatment failure
(if symptoms persist after 48-72 hours of Amoxicillin) or if the child had antibiotics
recently.
, [Type here]
Question 8
You are evaluating a patient with a "Drop Arm" test. The patient is unable to slowly lower
their arm from 90 degrees of abduction; it drops suddenly. This finding is highly specific
for:
A) Bicipital Tendonitis
B) Rotator Cuff Tear (specifically Supraspinatus)
C) Adhesive Capsulitis (Frozen Shoulder)
D) Acromioclavicular (AC) Separation
E) Glenohumeral Dislocation
Correct Answer: B) Rotator Cuff Tear (specifically Supraspinatus)
Rationale: The Drop Arm test assesses the integrity of the rotator cuff, specifically the
supraspinatus tendon. Inability to control the lowering of the arm indicates a full-thickness
tear.
Question 9
A 22-year-old female presents with lower abdominal pain, fever, and vaginal discharge. On
physical exam, she has marked Cervical Motion Tenderness (Chandelier Sign). What is the
most likely diagnosis?
A) Ectopic Pregnancy
B) Appendicitis
C) Pelvic Inflammatory Disease (PID)
D) Ovarian Cyst Rupture
E) Urinary Tract Infection
Correct Answer: C) Pelvic Inflammatory Disease (PID)
Rationale: The classic triad for PID is pelvic pain, adnexal tenderness, and cervical motion
tenderness (CMT). The "Chandelier Sign" refers to the patient reaching up in pain (as if to
grab a chandelier) during the bimanual exam due to the severity of the CMT.
Question 10
According to the GOLD guidelines for COPD, which class of medication is the foundation
of therapy for patients with Group B or higher (symptomatic) COPD?
A) Short-Acting Beta Agonists (SABA) only
B) Inhaled Corticosteroids (ICS) monotherapy
C) Long-Acting Muscarinic Antagonists (LAMA) or Long-Acting Beta Agonists (LABA)
D) Systemic Steroids (Prednisone)
E) Antibiotics (Azithromycin)
