NR667 VISE II 2026 ACTUAL SCRIPT
COMPLETE QUESTIONS AND ANSWERS 100%
CORRECT
◉ Assessment findings: Hypothyroidism. Answer: -Clinical
symptoms range from asymptomatic to myxedema coma
-Lethargy, delayed DTRs
-Mild weight gain, swelling of hands/feet, macroglossia (large
tongue), periorbital edema
-Cold intolerance
-Constipation
-Menstrual irregularities, decreased libido, infertility
-Memory loss, depression
-Course dry skin; body and scalp hair loss, brittle nails
-Bradycardia, enlarged heart
-Anemia
*Expect lipid levels to be elevated
◉ Differential diagnosis: Hypothyroidism. Answer: -Depression
-Dementia
-Heart failure
-Kidney failure
,◉ Final diagnosis: Hypothyroidism. Answer: -Serum TSH is
increased in thymoprivic (rare) and goitrous hypothyroidism (>20)
-TSH is normal or undetectable in pituitary or hypothalamic
hypothyroidism
-T43 decreased most commonly; occasionally t3
◉ Prevention: Hypothyroidism. Answer: -Periodic monitoring of
thyroid hormone levels for patients treated for hyperthyroidism
-Identification of risk factors
-Newborn thyroid screening at 2-6 days of age
◉ Non-pharm management: Hypothyroidism. Answer: -Educate
patients that children may have behavioral problems at the start of
treatment
-High-fiber diet to prevent constipation
-If obese, diet for weight loss/body fat reduction
-Educate about the need for life-long adherence to thyroid
replacement and to report signs of toxicity, infection, or cardiac
symptoms
-Annual lipid level assessment
,◉ Pharmacological management: Hypothyroidism. Answer: -L-
thyroxine daily; begin at lower dose in older adults or in the
presence of cardiac disease (25 mcg/daily)
-In young healthy patients: 1.6mcg/kg/day
-Older patients: start at 12.5-50mcg/day
-Adult maintenance: 50-200mcg/day
-Infants: 6-15 mcg/kg/day based on age
-Children: 4-6 mcg/kg/day based on age
*Rapid replacement in infants and children results in attainment of
normal IQ
◉ Pregnancy/lactation considerations: Hypothyroidism. Answer: -At
8 weeks gestation, levothyroxine dose requirements rise by 25-50%
-TSH should be assessed every 4 weeks during the first half of
pregnancy, then less frequent (once every trimester)
-Reduce levothyroxine dose to pre-pregnancy dose immediately
after delivery
-Breastfeeding is not a contraindication to levothyroxine therapy
◉ Follow-up: Hypothyroidism. Answer: -Measure TSH after 6 weeks
of therapy and every 6-8 weeks until goal is met; then annually
UNLESS symptomatic
-Examine periodically for signs of thyrotoxicity (i.e. tremor or
tachycardia)
, -Congenital hypothyroidism: periodically monitor t4 and TSH
◉ Expected course: Hypothyroidism. Answer: -Improvement is
expected 2 weeks after medication initiation
-Signs and symptoms shoulder resolve in 3-6 months
-Lifelong therapy is needed
◉ Possible complications: Hypothyroidism. Answer: -Myxedema
coma: life-threatening, severe hypothyroidism; may require IV
levothyroxine and cardiorespiratory assistance
-Thyrotoxicity
-Treatment-induced heart failure in older adults or patients with
CAD
-Bone demineralization due to over treatment for a long period
-Without treatment, congenital hypothyroidism may lead to mental
retardation
-Growth and development delays
-Increased risk of infection
-Sexual dysfunction
-Infertility
-Miscarriage
-Megacolon
-Adrenal crisis
COMPLETE QUESTIONS AND ANSWERS 100%
CORRECT
◉ Assessment findings: Hypothyroidism. Answer: -Clinical
symptoms range from asymptomatic to myxedema coma
-Lethargy, delayed DTRs
-Mild weight gain, swelling of hands/feet, macroglossia (large
tongue), periorbital edema
-Cold intolerance
-Constipation
-Menstrual irregularities, decreased libido, infertility
-Memory loss, depression
-Course dry skin; body and scalp hair loss, brittle nails
-Bradycardia, enlarged heart
-Anemia
*Expect lipid levels to be elevated
◉ Differential diagnosis: Hypothyroidism. Answer: -Depression
-Dementia
-Heart failure
-Kidney failure
,◉ Final diagnosis: Hypothyroidism. Answer: -Serum TSH is
increased in thymoprivic (rare) and goitrous hypothyroidism (>20)
-TSH is normal or undetectable in pituitary or hypothalamic
hypothyroidism
-T43 decreased most commonly; occasionally t3
◉ Prevention: Hypothyroidism. Answer: -Periodic monitoring of
thyroid hormone levels for patients treated for hyperthyroidism
-Identification of risk factors
-Newborn thyroid screening at 2-6 days of age
◉ Non-pharm management: Hypothyroidism. Answer: -Educate
patients that children may have behavioral problems at the start of
treatment
-High-fiber diet to prevent constipation
-If obese, diet for weight loss/body fat reduction
-Educate about the need for life-long adherence to thyroid
replacement and to report signs of toxicity, infection, or cardiac
symptoms
-Annual lipid level assessment
,◉ Pharmacological management: Hypothyroidism. Answer: -L-
thyroxine daily; begin at lower dose in older adults or in the
presence of cardiac disease (25 mcg/daily)
-In young healthy patients: 1.6mcg/kg/day
-Older patients: start at 12.5-50mcg/day
-Adult maintenance: 50-200mcg/day
-Infants: 6-15 mcg/kg/day based on age
-Children: 4-6 mcg/kg/day based on age
*Rapid replacement in infants and children results in attainment of
normal IQ
◉ Pregnancy/lactation considerations: Hypothyroidism. Answer: -At
8 weeks gestation, levothyroxine dose requirements rise by 25-50%
-TSH should be assessed every 4 weeks during the first half of
pregnancy, then less frequent (once every trimester)
-Reduce levothyroxine dose to pre-pregnancy dose immediately
after delivery
-Breastfeeding is not a contraindication to levothyroxine therapy
◉ Follow-up: Hypothyroidism. Answer: -Measure TSH after 6 weeks
of therapy and every 6-8 weeks until goal is met; then annually
UNLESS symptomatic
-Examine periodically for signs of thyrotoxicity (i.e. tremor or
tachycardia)
, -Congenital hypothyroidism: periodically monitor t4 and TSH
◉ Expected course: Hypothyroidism. Answer: -Improvement is
expected 2 weeks after medication initiation
-Signs and symptoms shoulder resolve in 3-6 months
-Lifelong therapy is needed
◉ Possible complications: Hypothyroidism. Answer: -Myxedema
coma: life-threatening, severe hypothyroidism; may require IV
levothyroxine and cardiorespiratory assistance
-Thyrotoxicity
-Treatment-induced heart failure in older adults or patients with
CAD
-Bone demineralization due to over treatment for a long period
-Without treatment, congenital hypothyroidism may lead to mental
retardation
-Growth and development delays
-Increased risk of infection
-Sexual dysfunction
-Infertility
-Miscarriage
-Megacolon
-Adrenal crisis
