The following questions are free-response questions. To ensure answers are graded correctly, please complete your work for each question on its own piece of paper. Upload a PDF or images of your work. PDFs are preferred. If you need to upload multiple images for a question, there are blank questions at the end of the exam where you can upload additional images. Please indicate in the image uploaded to the original exam question that there are additional images uploaded at the end of the exam. Clearly indicate on each page you upload which problem your work corresponds to. You may use a phone or other device to take pictures of your work to upload, but that device may not be used to assist in solving the problems.

A patient is complaining of ‘vision changes’. When asking the patient about his symptoms he reports floaters, flashes of light, and a loss of parts of a visual field. As an FNP you know that ____ are a common symptom of both retinal detachment and vitreous hemorrhage. However, on physical examination you expect to see ____ because of the reported flashes of light and loss of a visual field.

A 26-year-old patient comes in complaining of gradual hearing loss. On physical examination you note a cholesteatoma in the right ear. You know it is important to ask if they have a past medical history of:

A 43-year-old patient presents to the clinic for follow-up regarding elevated liver enzymes. On physical examination, you note that the tongue is red and smooth. The patient notes that his mouth has been sensitive recently. Which of the following tests would you order to help confirm your suspicions about the cause of the changes to the patient’s tongue?

A 70-year-old patient presents with multiple, well-defined, brownish, and slightly raised lesions on his/her chest, back, and face. The lesions have a “stuck-on” appearance and feel rough to the touch. The patient reports that the lesions have been slowly developing over the past few years and are not painful or itchy. Based on the clinical presentation, which of the following is the most likely diagnosis and next step in management?

A female patient with asthma reports that over the past month, she wakes up 1-2 times per week short of breath and needing to use her rescue inhaler. She also reports shortness of breath interfering with daily activities several times per week. She is able to talk in full sentences and have a mild wheeze on auscultation. Is the patient’s asthma:

A 24-year-old patient presents for a consultation regarding depression. The patient is regularly seen by a mental health counselor and during their most recent sessions, they’ve discussed some of the benefits of antidepressant medication. The patient would like to discuss options for medical management of her depression. Prior to initiating therapy with an SSRI, you decide to get an EKG. You know it is important to evaluate the patient for:

A 16-year-old patient presents with a history of persistent acne for the past 6 months. On examination, the patient has many comedones and some papules/pustules on the face. There is no scarring or cystic acne. Based on the severity of the acne, how would you stage this patient’s acne?

You are seeing a patient with a history of allergic rhinitis for their annual physical. During your review of systems, your patient notes that he has had a ‘drippy’ nose over the past few weeks. On physical exam, you expect to find:

A 62-year-old smoker presents with shortness of breath. On examination, the patient has a prolonged expiratory phase and decreased breath sounds. Pulmonary function tests reveal increased total lung capacity. The patient’s chest X-ray shows hyperinflation with a flattened diaphragm. Which condition is most likely?