NR509vj FINALv j Batesv j Questionsv j Studyv j S
et
1. 44v j yearv j oldv j femalev j mathematicianv j c/ov j massv j tov j rightv j breast.v j nov j familyv j hist
oryvjofvjbreastvjcancer.vjbenignvjcystvjshown.vjwhatvjadvicevjshouldvjbevjgivenvjaboutvjscre
en-
v j ing?:vjthisvjpatientvjwasvjinvjcompliance vjwithvjthevjU.S.vjPreventative vjServicesvjTaskvjForcevj(USPSTF)vjrecommendatio
nsvjforvjhervjagevjgroupvjandvjriskvjfactorsvjpriorvjtovjhervjcurrentvjcomplaint.
2. 42vjyearvjoldvjfemalevjwebsitevjdeveloper.vjhasvjquestionsvjaboutvjbreastvjcancervjs
creening.vjconcernedvjaboutvjradiationvjexposure.vjwhichvjofvjthevjfollowingvjisvjtruevj
aboutvjMRIvjasvjavjscreeningvjmodalityvjforvjbreastvjcancervjinvjthevjgeneralvjpopulation?-
:v j sensitivityvjscreeningvjforvjbreastvjcancervjincreasesvjwithvjbreastvjMRIvjatvjthevjexpensevjofvjspecificity.
3. Avj35-year-
oldvjG0P0vjwomanvjpresentsvjtovjclinicvjwithvjavjcomplaintvjofvjbilateralvjnipplev j dischar
ge.v j Thisv j dischargev j startedv j severalv j weeksv j agov j andv j hasv j occurredv j atvjirregularv j i
ntervalsv j sincev j thatv j time.v j Shev j doesv j notv j complainv j ofv j localv j tenderness,v j redne
ss,vjfever,vjorvjanyvjothervjsystemicvjsymptomsvjasidevjfromvjslightlyvjirregularvjperio
dsvjovervjthevjlastvjfewvjmonths.vjOnvjexamination,vjshevjisvjablevjtovjexpressvjavjsmallvj
amountvjofvjdischarge,vjwhichvjisvjsentvjtovjthevjlaboratoryvjandvjfoundvjtovjbevjconsi
stentvjwithvjbreastvjmilkvjbutvjwithoutvjanyvjsignsvjofvjbloodvjorvjpus.vjScreeningvjlabor
atoriesv j arev j alsov j sent,v j whichv j revealv j av j normalv j bloodv j count,v j metabolicv j panel,vjt
hyroid-
stimulatingv j hormone,v j andv j humanv j chorionicv j gonadotropinv j (HCG)v j level.vjFur
thervjlaboratoriesvjarevjstillvjpending.vjWhichvjofvjthevjfollowingvjisvjthevjmostvjlikelyvjdia
gnosis?:vjProlactinoma
4. Av j 22-year-
oldv j G0P0v j undergraduatev j studentv j presentsv j tov j clinicv j afterv j findingv j av j breastv j m
assv j onv j breastv j self-
examinationv j (BSE)v j atv j home.v j Thev j massv j isv j nontendervjwithoutv j skinv j changes,v j
erythema,v j orv j overlyingv j swelling.v j Shev j hasv j heardv j thatv j mostvjbreastv j cancersv j ar
ev j foundv j byv j patientsv j themselves,v j andv j shev j isv j veryv j concernedvjthatv j shev j mayv j h
avev j breastv j cancer.v j Whichv j ofv j thev j followingv j isv j truev j aboutv j BSEv j andvjself-
detectionvjofvjbreastvjcancer?:vjThisvjpatientvjisvjmorevjlikelyvjtovjfindvjavjfibroadenomavjthanvjavjcancervjonvjsel
f-examination
5. 48vjyearvjoldvjpsychologistvjconcernsvjaboutvjbreastvjcancervjriskvjaftervjan
, NR509vj FINALv j Batesv j Questionsv j Studyv j S
et
age-
marchedv j cousinv j recentlyv j diagnosed.v j patientv j readv j aboutv j testingv j forv j brea
stvjcancerv j genesv j (BRCA1v j andv j BRCA2)v j andv j desiresv j furtherv j informationv j aboutv
jwhetherv j thisv j wouldv j bev j appropriatev j forv j her.v j Whichv j ofv j thev j followingv j isv j truev j a
boutvjthisvjpatient'svjindicationsvjforvjBRCAvjtesting?:vjthisvjpatientvjcarriesvjseveralvjriskvjfactorsvjthatvjto
gethervjjustifyvjBRCAvjtesting.
, NR509vj FINALv j Batesv j Questionsv j Studyv j S
et
6. Av j 68-year-
oldv j formerv j paleontologistv j presentsv j tov j clinicv j withv j concernsv j aboutvjherv j brea
stv j cancerv j risk.v j Herv j motherv j developedv j thev j diseasev j inv j herv j 50sv j andv j diedvjfrom
v j itv j inv j herv j 60s.v j Av j youngerv j cousinv j developedv j thev j diseasev j av j fewv j yearsv j agovjb
eforev j thev j agev j ofv j 50v j years,v j butv j thisv j individualv j wasv j notv j testedv j forv j thev j BRCA
1vjandv j BRCA2v j genes.v j Inv j addition,v j thev j patientv j sufferedv j fromv j lymphomav j inv j he
rv j 20svjandv j hadv j radiationv j tov j thev j chest.v j Shev j didv j takev j hormonev j replacementv j t
herapyv j forv j av j fewv j yearsv j beforev j datav j emergedv j thatv j thisv j mayv j contributev j tov j br
eastv j cancerv j risk.vjShev j hasv j hadv j severalv j abnormalv j mammogramsv j inv j herv j 50sv j f
orv j persistentlyv j densevjbreastsv j withv j subtlev j findings,v j butv j follow-
upv j biopsiesv j neverv j showedv j anyv j malig-
v j nantv j pathology.v j Whichv j ofv j thev j followingv j isv j truev j regardingv j magneticv j re
sonancevjimagingvj(MRI)vjscreeningvjofvjthisvjpatient?:vjRegardlessvjofvjrecommendations,vjthevjhighvjse
nsitivityvjofvjbreastvjMRIvjcomesvjatvjthevjexpensevjofvjmarkedlyvjdecreasedvjspecificityvj(i.e.vjthevjabilityvjtovjrulevjoutvjdiseasevjinvjh
ealthyvjbreasts).
7. 66v j yearv j oldv j femalev j museumv j curatorv j presentsv j forv j av j routinev j annualv j exam-
ination.v j onv j examination,v j av j notablyv j enlargedv j supraclavicularv j lymphv j nodev j is
v j appreciatedv j onv j thev j rightv j side.v j nonv j tenderv j andv j feelsv j firmv j andv j rubbery.v j d
eniesv j anyv j localizedv j orv j systemicv j symptoms.v j hasv j beenv j takingv j estrogenv j forv j
9v j yearsvjsincev j menopause.v j Whichv j ofv j thev j followingv j isv j truev j aboutv j thisv j prese
ntationv j ofv j lymphadenopathy?:vjMetastaticvjbreastvjcancervjcellsvjmayvjspreadvjdirectlyvjintovjthevjinfraclav
icularvjandvjthenvjsupraclavicularvjnodesvjwithoutvjfirstvjcausingvjnotablevjchangesvjinvjthevjaxillaryvjnodes.
8. 24v j yearv j oldv j graphicv j designerv j presentsv j tov j thev j clinicv j withv j av j concernv j forv j av j b
reastvjmass.v j rubbery,v j mobile,v j nontenderv j massv j isv j palpatedv j inv j thev j rightv j breast
,v j whichv j isvjconsistentv j withv j av j fibroadenoma.v j examinerv j notesv j av j 3cmv j massv j pro
ximalv j tov j andv j 3cmv j leftv j ofv j thev j nipple.v j Whichv j ofv j thev j followingv j wouldv j bev j thev j
mostv j appropriatev j wayvjtovjreportvjthisvjfinding?:vj"Rubbery,vjmobile,vjnontendervjmassvjlocatedvjinvjthev
jrightvjbreast,vjinvjthevj10:30vjpositionvjfromvjthevjnipple"
9. 54v j yearv j oldv j femalev j dieticianv j presentsv j forv j av j routinev j examination.v j reportsv j h
asv j hadv j manyv j breastv j findingsv j overv j severalv j years,v j includingv j onev j biopsyv j with
v j normalvjpathology.v j Shev j feelsv j thatv j herv j breastsv j havev j becomev j farv j lessv j lumpyv
j sincev j shevjunderwentv j menopausev j 3v j yearsv j ago.v j Whichv j ofv j thev j followingv j isv j tru
et
1. 44v j yearv j oldv j femalev j mathematicianv j c/ov j massv j tov j rightv j breast.v j nov j familyv j hist
oryvjofvjbreastvjcancer.vjbenignvjcystvjshown.vjwhatvjadvicevjshouldvjbevjgivenvjaboutvjscre
en-
v j ing?:vjthisvjpatientvjwasvjinvjcompliance vjwithvjthevjU.S.vjPreventative vjServicesvjTaskvjForcevj(USPSTF)vjrecommendatio
nsvjforvjhervjagevjgroupvjandvjriskvjfactorsvjpriorvjtovjhervjcurrentvjcomplaint.
2. 42vjyearvjoldvjfemalevjwebsitevjdeveloper.vjhasvjquestionsvjaboutvjbreastvjcancervjs
creening.vjconcernedvjaboutvjradiationvjexposure.vjwhichvjofvjthevjfollowingvjisvjtruevj
aboutvjMRIvjasvjavjscreeningvjmodalityvjforvjbreastvjcancervjinvjthevjgeneralvjpopulation?-
:v j sensitivityvjscreeningvjforvjbreastvjcancervjincreasesvjwithvjbreastvjMRIvjatvjthevjexpensevjofvjspecificity.
3. Avj35-year-
oldvjG0P0vjwomanvjpresentsvjtovjclinicvjwithvjavjcomplaintvjofvjbilateralvjnipplev j dischar
ge.v j Thisv j dischargev j startedv j severalv j weeksv j agov j andv j hasv j occurredv j atvjirregularv j i
ntervalsv j sincev j thatv j time.v j Shev j doesv j notv j complainv j ofv j localv j tenderness,v j redne
ss,vjfever,vjorvjanyvjothervjsystemicvjsymptomsvjasidevjfromvjslightlyvjirregularvjperio
dsvjovervjthevjlastvjfewvjmonths.vjOnvjexamination,vjshevjisvjablevjtovjexpressvjavjsmallvj
amountvjofvjdischarge,vjwhichvjisvjsentvjtovjthevjlaboratoryvjandvjfoundvjtovjbevjconsi
stentvjwithvjbreastvjmilkvjbutvjwithoutvjanyvjsignsvjofvjbloodvjorvjpus.vjScreeningvjlabor
atoriesv j arev j alsov j sent,v j whichv j revealv j av j normalv j bloodv j count,v j metabolicv j panel,vjt
hyroid-
stimulatingv j hormone,v j andv j humanv j chorionicv j gonadotropinv j (HCG)v j level.vjFur
thervjlaboratoriesvjarevjstillvjpending.vjWhichvjofvjthevjfollowingvjisvjthevjmostvjlikelyvjdia
gnosis?:vjProlactinoma
4. Av j 22-year-
oldv j G0P0v j undergraduatev j studentv j presentsv j tov j clinicv j afterv j findingv j av j breastv j m
assv j onv j breastv j self-
examinationv j (BSE)v j atv j home.v j Thev j massv j isv j nontendervjwithoutv j skinv j changes,v j
erythema,v j orv j overlyingv j swelling.v j Shev j hasv j heardv j thatv j mostvjbreastv j cancersv j ar
ev j foundv j byv j patientsv j themselves,v j andv j shev j isv j veryv j concernedvjthatv j shev j mayv j h
avev j breastv j cancer.v j Whichv j ofv j thev j followingv j isv j truev j aboutv j BSEv j andvjself-
detectionvjofvjbreastvjcancer?:vjThisvjpatientvjisvjmorevjlikelyvjtovjfindvjavjfibroadenomavjthanvjavjcancervjonvjsel
f-examination
5. 48vjyearvjoldvjpsychologistvjconcernsvjaboutvjbreastvjcancervjriskvjaftervjan
, NR509vj FINALv j Batesv j Questionsv j Studyv j S
et
age-
marchedv j cousinv j recentlyv j diagnosed.v j patientv j readv j aboutv j testingv j forv j brea
stvjcancerv j genesv j (BRCA1v j andv j BRCA2)v j andv j desiresv j furtherv j informationv j aboutv
jwhetherv j thisv j wouldv j bev j appropriatev j forv j her.v j Whichv j ofv j thev j followingv j isv j truev j a
boutvjthisvjpatient'svjindicationsvjforvjBRCAvjtesting?:vjthisvjpatientvjcarriesvjseveralvjriskvjfactorsvjthatvjto
gethervjjustifyvjBRCAvjtesting.
, NR509vj FINALv j Batesv j Questionsv j Studyv j S
et
6. Av j 68-year-
oldv j formerv j paleontologistv j presentsv j tov j clinicv j withv j concernsv j aboutvjherv j brea
stv j cancerv j risk.v j Herv j motherv j developedv j thev j diseasev j inv j herv j 50sv j andv j diedvjfrom
v j itv j inv j herv j 60s.v j Av j youngerv j cousinv j developedv j thev j diseasev j av j fewv j yearsv j agovjb
eforev j thev j agev j ofv j 50v j years,v j butv j thisv j individualv j wasv j notv j testedv j forv j thev j BRCA
1vjandv j BRCA2v j genes.v j Inv j addition,v j thev j patientv j sufferedv j fromv j lymphomav j inv j he
rv j 20svjandv j hadv j radiationv j tov j thev j chest.v j Shev j didv j takev j hormonev j replacementv j t
herapyv j forv j av j fewv j yearsv j beforev j datav j emergedv j thatv j thisv j mayv j contributev j tov j br
eastv j cancerv j risk.vjShev j hasv j hadv j severalv j abnormalv j mammogramsv j inv j herv j 50sv j f
orv j persistentlyv j densevjbreastsv j withv j subtlev j findings,v j butv j follow-
upv j biopsiesv j neverv j showedv j anyv j malig-
v j nantv j pathology.v j Whichv j ofv j thev j followingv j isv j truev j regardingv j magneticv j re
sonancevjimagingvj(MRI)vjscreeningvjofvjthisvjpatient?:vjRegardlessvjofvjrecommendations,vjthevjhighvjse
nsitivityvjofvjbreastvjMRIvjcomesvjatvjthevjexpensevjofvjmarkedlyvjdecreasedvjspecificityvj(i.e.vjthevjabilityvjtovjrulevjoutvjdiseasevjinvjh
ealthyvjbreasts).
7. 66v j yearv j oldv j femalev j museumv j curatorv j presentsv j forv j av j routinev j annualv j exam-
ination.v j onv j examination,v j av j notablyv j enlargedv j supraclavicularv j lymphv j nodev j is
v j appreciatedv j onv j thev j rightv j side.v j nonv j tenderv j andv j feelsv j firmv j andv j rubbery.v j d
eniesv j anyv j localizedv j orv j systemicv j symptoms.v j hasv j beenv j takingv j estrogenv j forv j
9v j yearsvjsincev j menopause.v j Whichv j ofv j thev j followingv j isv j truev j aboutv j thisv j prese
ntationv j ofv j lymphadenopathy?:vjMetastaticvjbreastvjcancervjcellsvjmayvjspreadvjdirectlyvjintovjthevjinfraclav
icularvjandvjthenvjsupraclavicularvjnodesvjwithoutvjfirstvjcausingvjnotablevjchangesvjinvjthevjaxillaryvjnodes.
8. 24v j yearv j oldv j graphicv j designerv j presentsv j tov j thev j clinicv j withv j av j concernv j forv j av j b
reastvjmass.v j rubbery,v j mobile,v j nontenderv j massv j isv j palpatedv j inv j thev j rightv j breast
,v j whichv j isvjconsistentv j withv j av j fibroadenoma.v j examinerv j notesv j av j 3cmv j massv j pro
ximalv j tov j andv j 3cmv j leftv j ofv j thev j nipple.v j Whichv j ofv j thev j followingv j wouldv j bev j thev j
mostv j appropriatev j wayvjtovjreportvjthisvjfinding?:vj"Rubbery,vjmobile,vjnontendervjmassvjlocatedvjinvjthev
jrightvjbreast,vjinvjthevj10:30vjpositionvjfromvjthevjnipple"
9. 54v j yearv j oldv j femalev j dieticianv j presentsv j forv j av j routinev j examination.v j reportsv j h
asv j hadv j manyv j breastv j findingsv j overv j severalv j years,v j includingv j onev j biopsyv j with
v j normalvjpathology.v j Shev j feelsv j thatv j herv j breastsv j havev j becomev j farv j lessv j lumpyv
j sincev j shevjunderwentv j menopausev j 3v j yearsv j ago.v j Whichv j ofv j thev j followingv j isv j tru
